Provider Demographics
NPI:1881900371
Name:PLOURDE, MELISSA (OT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:PLOURDE
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 1:12 TIGER DR
Mailing Address - Street 2:JAY SCHOOL DEPARTMENT
Mailing Address - City:JAY
Mailing Address - State:ME
Mailing Address - Zip Code:04239-1518
Mailing Address - Country:US
Mailing Address - Phone:207-897-5271
Mailing Address - Fax:207-897-4657
Practice Address - Street 1:12 TIGER DR
Practice Address - Street 2:JAY SCHOOL DEPARTMENT
Practice Address - City:JAY
Practice Address - State:ME
Practice Address - Zip Code:04239-1518
Practice Address - Country:US
Practice Address - Phone:207-897-5271
Practice Address - Fax:207-897-4657
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT1209225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist