Provider Demographics
NPI:1871672592
Name:WINKLE, MELISSA Y (OTR/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:Y
Last Name:WINKLE
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 1:3108 ALAMOGORDO DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1108
Mailing Address - Country:US
Mailing Address - Phone:505-433-2583
Mailing Address - Fax:866-904-9976
Practice Address - Street 1:3108 ALAMOGORDO DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1108
Practice Address - Country:US
Practice Address - Phone:505-433-2583
Practice Address - Fax:866-904-9976
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1775225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM03556239Medicaid
NM03006514Medicare PIN