Healthcare Provider Details

I. General information

NPI: 1942080650
Provider Name (Legal Business Name): MELISSA MARIE MACDONALD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 09/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 PINE ST
SAN FRANCISCO CA
94109-4807
US

IV. Provider business mailing address

154 10TH ST APT 6
SAN FRANCISCO CA
94103-2624
US

V. Phone/Fax

Practice location:
  • Phone: 415-673-8405
  • Fax:
Mailing address:
  • Phone: 415-882-7301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number15585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: