Provider Demographics
NPI:1295873057
Name:GRACE, MELINDA C (ATC, OT)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:C
Last Name:GRACE
Suffix:
Gender:F
Credentials:ATC, OT
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:CORBETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:24 FRANK LLOYD WRIGHT DR
Mailing Address - Street 2:PO BOX 391
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9755
Mailing Address - Country:US
Mailing Address - Phone:734-930-7415
Mailing Address - Fax:
Practice Address - Street 1:24 FRANK LLOYD WRIGHT DR
Practice Address - Street 2:MEDSPORT
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9755
Practice Address - Country:US
Practice Address - Phone:734-930-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer