Healthcare Provider Details

I. General information

NPI: 1427119304
Provider Name (Legal Business Name): MELANIE IRENE THOMPSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELANIE CONATSER

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W UNIVERSITY DR
MESA AZ
85201-5818
US

IV. Provider business mailing address

25759 S 194TH ST
QUEEN CREEK AZ
85142-6106
US

V. Phone/Fax

Practice location:
  • Phone: 480-688-1917
  • Fax: 480-668-2750
Mailing address:
  • Phone: 602-793-9676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number3009
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTH-003009
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier751190
Identifier TypeMEDICAID
Identifier StateAZ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: