Provider Demographics
NPI:1245726900
Name:MOULTON, MELINDA FERRIS (OTR/L)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:FERRIS
Last Name:MOULTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LINDE
Other - Middle Name:FERRIS
Other - Last Name:MOULTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:10237 W 52ND PL # 8-301
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6613
Mailing Address - Country:US
Mailing Address - Phone:562-252-2117
Mailing Address - Fax:
Practice Address - Street 1:695 S COLORADO BLVD STE 20
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-8010
Practice Address - Country:US
Practice Address - Phone:303-360-0727
Practice Address - Fax:303-360-0758
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005358225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist