Provider Demographics
NPI:1649336777
Name:DUGGER, MELISSA JOANN (OTR)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JOANN
Last Name:DUGGER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 N HIGHWAY 95
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711-2346
Mailing Address - Country:US
Mailing Address - Phone:417-256-5669
Mailing Address - Fax:417-256-5699
Practice Address - Street 1:1480 W 8TH ST
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775
Practice Address - Country:US
Practice Address - Phone:417-256-5669
Practice Address - Fax:417-256-5699
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001160261QR0400X, 282N00000X, 314000000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No282N00000XHospitalsGeneral Acute Care Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO001160OtherLICENSED OTR