Provider Demographics
NPI:1013272947
Name:SMITHWICK, MELINDA J (OTR/L, ATP,CDRS)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:J
Last Name:SMITHWICK
Suffix:
Gender:F
Credentials:OTR/L, ATP,CDRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 W ELFINDALE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-1287
Mailing Address - Country:US
Mailing Address - Phone:417-831-0555
Mailing Address - Fax:417-831-0532
Practice Address - Street 1:1661 W ELFINDALE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-1287
Practice Address - Country:US
Practice Address - Phone:417-831-0555
Practice Address - Fax:417-831-0532
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005104225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist