Provider Demographics
NPI:1255426797
Name:RIDGWAY, MELANIE D (OTR/L)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:D
Last Name:RIDGWAY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2307 PARKLAND WAY
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6536
Mailing Address - Country:US
Mailing Address - Phone:405-579-2457
Mailing Address - Fax:580-248-2329
Practice Address - Street 1:2307 PARKLAND WAY
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6536
Practice Address - Country:US
Practice Address - Phone:405-579-2457
Practice Address - Fax:580-248-2329
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK728225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100639300BMedicaid
OK100639300CMedicaid