Healthcare Provider Details

I. General information

NPI: 1386690352
Provider Name (Legal Business Name): MELINDA J BRUER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINDA J BRUER OT

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W TYRONE RD
OAK RIDGE TN
37830-6517
US

IV. Provider business mailing address

225 HOLDER CEMETERY RD
TELLICO PLAINS TN
37385-5997
US

V. Phone/Fax

Practice location:
  • Phone: 865-276-3852
  • Fax:
Mailing address:
  • Phone: 865-309-5658
  • Fax: 423-261-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number197786
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number000339
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: