Healthcare Provider Details

I. General information

NPI: 1659201523
Provider Name (Legal Business Name): MELISHA LYNN JANSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W PLUM ST
COLDWATER OH
45828-1144
US

IV. Provider business mailing address

403 W PLUM ST
COLDWATER OH
45828-1144
US

V. Phone/Fax

Practice location:
  • Phone: 419-953-0188
  • Fax:
Mailing address:
  • Phone: 419-953-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number007504
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: