Provider Demographics
NPI:1851414080
Name:MELSON, HEATHER (OT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MELSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 HIGHLAND CIR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-5415
Mailing Address - Country:US
Mailing Address - Phone:931-684-3833
Mailing Address - Fax:
Practice Address - Street 1:197 HIGHLAND CIR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-5415
Practice Address - Country:US
Practice Address - Phone:931-684-3833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOT0000002147225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4022798OtherBLUE CROSS BLUE SHIELD