Provider Demographics
NPI:1982267266
Name:ARCINIEGA, MELISSA (OTR)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:ARCINIEGA
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 1:1311 N HARLEM AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-1366
Mailing Address - Country:US
Mailing Address - Phone:773-682-2804
Mailing Address - Fax:
Practice Address - Street 1:1311 N HARLEM AVE APT 1C
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1366
Practice Address - Country:US
Practice Address - Phone:773-682-2804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist