Healthcare Provider Details

I. General information

NPI: 1265732614
Provider Name (Legal Business Name): MELISSA A BROWN OTR/L, PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13586 KERBY TIMBER RD
GLENWOOD MO
63541-1098
US

IV. Provider business mailing address

13586 KERBY TIMBER RD
GLENWOOD MO
63541-1098
US

V. Phone/Fax

Practice location:
  • Phone: 660-216-2591
  • Fax: 660-216-2591
Mailing address:
  • Phone: 660-216-2591
  • Fax: 660-216-2591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2026016245
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number2010024921
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: