Provider Demographics
NPI:1881429686
Name:JAWAHIR, MELODIE
Entity type:Individual
Prefix:
First Name:MELODIE
Middle Name:
Last Name:JAWAHIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 GRANT LINE RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2492
Mailing Address - Country:US
Mailing Address - Phone:812-903-9633
Mailing Address - Fax:
Practice Address - Street 1:2818 GRANT LINE RD STE B
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2492
Practice Address - Country:US
Practice Address - Phone:812-903-9633
Practice Address - Fax:812-984-0004
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31006495A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist