Provider Demographics
NPI:1922123546
Name:MCCLURE, MELANIE DAWN (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:DAWN
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:DAWN
Other - Last Name:HOFFARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:306 SOUTH 6TH STREET
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601
Mailing Address - Country:US
Mailing Address - Phone:541-887-7362
Mailing Address - Fax:541-273-2486
Practice Address - Street 1:306 SOUTH 6TH STREET
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601
Practice Address - Country:US
Practice Address - Phone:541-887-7362
Practice Address - Fax:541-273-2486
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002023104225XP0200X
OR1053214225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO475904736Medicaid