Provider Demographics
NPI:1710441845
Name:BARTLETT, MELODY PLEMMONS (OTR/L)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:PLEMMONS
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29100 GATEWAY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134-2764
Mailing Address - Country:US
Mailing Address - Phone:734-379-7900
Mailing Address - Fax:734-379-9150
Practice Address - Street 1:29100 GATEWAY BLVD STE 400
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:MI
Practice Address - Zip Code:48134-2764
Practice Address - Country:US
Practice Address - Phone:734-379-7900
Practice Address - Fax:734-379-9150
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201001458225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist