Provider Demographics
NPI:1942215447
Name:COLYAR, MELODIE R (OTR,CHT)
Entity Type:Individual
Prefix:
First Name:MELODIE
Middle Name:R
Last Name:COLYAR
Suffix:
Gender:F
Credentials:OTR,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 RESEARCH PKWY
Mailing Address - Street 2:SUITE 225
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1070
Mailing Address - Country:US
Mailing Address - Phone:719-260-8400
Mailing Address - Fax:719-260-8405
Practice Address - Street 1:2435 RESEARCH PKWY
Practice Address - Street 2:SUITE 225
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1070
Practice Address - Country:US
Practice Address - Phone:719-260-2400
Practice Address - Fax:719-260-8405
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1541225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO805968Medicare PIN