Provider Demographics
NPI:1710151774
Name:CLIFFORD, MELISSA J (OTR)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:J
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 LAKE CLEARWATER PL
Mailing Address - Street 2:APT 638
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-7736
Mailing Address - Country:US
Mailing Address - Phone:317-833-3783
Mailing Address - Fax:317-284-1186
Practice Address - Street 1:3850 LAKE CLEARWATER PL
Practice Address - Street 2:APT 638
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-7736
Practice Address - Country:US
Practice Address - Phone:317-833-3783
Practice Address - Fax:317-284-1186
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003896A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist