Provider Demographics
NPI:1780207852
Name:SCHULTZE, MELINDA JAN (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:JAN
Last Name:SCHULTZE
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S 38TH ST APT 311
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-3465
Mailing Address - Country:US
Mailing Address - Phone:515-341-2629
Mailing Address - Fax:
Practice Address - Street 1:1600 E SUMMIT ST
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1709
Practice Address - Country:US
Practice Address - Phone:712-623-5156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-24
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA097009225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist