Provider Demographics
NPI:1356712913
Name:DAVIS, MELISSA ROBIN (OTR/L)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROBIN
Last Name:DAVIS
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 1:1532 ELLIS ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8808
Mailing Address - Country:US
Mailing Address - Phone:406-586-5694
Mailing Address - Fax:
Practice Address - Street 1:1532 ELLIS ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8808
Practice Address - Country:US
Practice Address - Phone:406-586-5694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOTP-OT-LIC3956225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist