Healthcare Provider Details

I. General information

NPI: 1245140417
Provider Name (Legal Business Name): MELISSA WALRAVEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 MERCANTILE WAY STE 1&2
LANSING MI
48911-6957
US

IV. Provider business mailing address

2145 ASPENWOOD DR
HOLT MI
48842-8725
US

V. Phone/Fax

Practice location:
  • Phone: 517-244-1430
  • Fax: 517-272-1216
Mailing address:
  • Phone: 517-203-8463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5201009402
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: