Provider Demographics
NPI:1780705764
Name:KURRUS, MELINDA BLAIR (OTR)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:BLAIR
Last Name:KURRUS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:BLAIR
Other - Last Name:WELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2605 E CREEKS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-8368
Mailing Address - Country:US
Mailing Address - Phone:812-333-2663
Mailing Address - Fax:812-676-4131
Practice Address - Street 1:1375 N WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-9786
Practice Address - Country:US
Practice Address - Phone:812-355-6933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31004096A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400062259Medicare PIN
IN555850051Medicare PIN