Provider Demographics
NPI:1912102591
Name:VIOLETTE, MELISSA MARIE (OTR)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:VIOLETTE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8767 SUGAR SAND LN NW
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-9716
Mailing Address - Country:US
Mailing Address - Phone:320-760-7867
Mailing Address - Fax:712-792-2218
Practice Address - Street 1:8767 SUGAR SAND LN NW
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-9716
Practice Address - Country:US
Practice Address - Phone:320-760-7867
Practice Address - Fax:712-792-2218
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN103573225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist