Provider Demographics
NPI:1740569326
Name:FERGUSON, MELODIE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MELODIE
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MS
Other - First Name:MELODIE
Other - Middle Name:
Other - Last Name:BROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:3380 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-9089
Mailing Address - Country:US
Mailing Address - Phone:317-718-0089
Mailing Address - Fax:317-718-0097
Practice Address - Street 1:3380 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-9089
Practice Address - Country:US
Practice Address - Phone:317-718-0089
Practice Address - Fax:317-718-0097
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005159A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist