Healthcare Provider Details

I. General information

NPI: 1891445706
Provider Name (Legal Business Name): AMY ELIZABETH MELANIPHY MSOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11411 183RD ST STE B
ORLAND PARK IL
60467-9451
US

IV. Provider business mailing address

17438 S MCCARRON RD
HOMER GLEN IL
60491-8236
US

V. Phone/Fax

Practice location:
  • Phone: 708-478-1820
  • Fax:
Mailing address:
  • Phone: 815-412-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056.014799
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: