Healthcare Provider Details

I. General information

NPI: 1306169271
Provider Name (Legal Business Name): MELISSA RENEA SNYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2010
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 BARNEY DR
JOLIET IL
60435-5271
US

IV. Provider business mailing address

212 BARNEY DR
JOLIET IL
60435-5271
US

V. Phone/Fax

Practice location:
  • Phone: 419-308-1099
  • Fax:
Mailing address:
  • Phone: 419-308-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056.009626
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: