Provider Demographics
NPI:1952457954
Name:REDINGTON, MELISSA MIRKAY (OT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MIRKAY
Last Name:REDINGTON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:MIRKAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:898 TOTEM WOODS CT
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7020
Mailing Address - Country:US
Mailing Address - Phone:314-609-3154
Mailing Address - Fax:
Practice Address - Street 1:4545 CENTRAL SCHOOL RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-7113
Practice Address - Country:US
Practice Address - Phone:636-851-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002210225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist