Provider Demographics
NPI:1871638957
Name:BIGELOW, MELISSA LEEANN (OTR)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEEANN
Last Name:BIGELOW
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 1:8948 RASMUSSEN CT
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-1668
Mailing Address - Country:US
Mailing Address - Phone:262-884-8659
Mailing Address - Fax:262-886-1115
Practice Address - Street 1:8948 RASMUSSEN CT
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-1668
Practice Address - Country:US
Practice Address - Phone:262-884-8659
Practice Address - Fax:262-886-1115
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3530-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41036100Medicaid