Provider Demographics
NPI:1740472968
Name:CLAIBORNE, MELISSA JANE (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JANE
Last Name:CLAIBORNE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:STRAWBERRY PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37871-0182
Mailing Address - Country:US
Mailing Address - Phone:865-933-8246
Mailing Address - Fax:865-465-3154
Practice Address - Street 1:566 OLD DANDRIDGE PIKE
Practice Address - Street 2:
Practice Address - City:STRAWBERRY PLAINS
Practice Address - State:TN
Practice Address - Zip Code:37871-3838
Practice Address - Country:US
Practice Address - Phone:865-933-8246
Practice Address - Fax:865-465-3154
Is Sole Proprietor?:No
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2772225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4146896OtherBLUE CROSS BLUE SHIELD