Healthcare Provider Details

I. General information

NPI: 1952575391
Provider Name (Legal Business Name): MELISSA ANNE NOVAK OTT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ANN NOVAK OTT DO

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 SE SUNNYSIDE RD
CLACKAMAS OR
97015-9777
US

IV. Provider business mailing address

500 NE MULTNOMAH ST STE 100
PORTLAND OR
97232-2031
US

V. Phone/Fax

Practice location:
  • Phone: 800-813-2000
  • Fax:
Mailing address:
  • Phone: 800-813-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberDO155928
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOP70089849
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: