Provider Demographics
NPI:1801289301
Name:KUNKLE, MELISSA ANN (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN
Last Name:KUNKLE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:ANN
Other - Last Name:STRINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:4201 NE 66TH AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661
Mailing Address - Country:US
Mailing Address - Phone:360-885-4684
Mailing Address - Fax:360-882-8972
Practice Address - Street 1:4201 NE 66TH AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661
Practice Address - Country:US
Practice Address - Phone:360-885-4684
Practice Address - Fax:360-882-8972
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60544253225X00000X
OR339184225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist