Provider Demographics
NPI:1205062254
Name:HOWARD, MELISSA (OTR)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1507
Mailing Address - Country:US
Mailing Address - Phone:608-417-5751
Mailing Address - Fax:608-417-5315
Practice Address - Street 1:202 S PARK ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1507
Practice Address - Country:US
Practice Address - Phone:608-417-5751
Practice Address - Fax:608-417-8050
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4843225X00000X
WI1771026225X00000X
WI1771225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1771026OtherSTATE OF WISCONSIN
982085OtherNATIONAL BOARD FOR CERTIFICATION IN OCCUPATIONAL THERAPY