Provider Demographics
NPI:1770974354
Name:KANNADY, MELISSA (OT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KANNADY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 740041
Mailing Address - Street 2:DEPT 6150
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-7441
Mailing Address - Country:US
Mailing Address - Phone:502-561-4295
Mailing Address - Fax:502-562-0348
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY STE 700
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3868
Practice Address - Country:US
Practice Address - Phone:502-561-4295
Practice Address - Fax:502-562-0348
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3306225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100334430Medicaid
KY7100334430Medicaid