Healthcare Provider Details

I. General information

NPI: 1568509446
Provider Name (Legal Business Name): MELANIE A SERPA OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 SE VILLAGE LOOP
VANCOUVER WA
98683-8103
US

IV. Provider business mailing address

13210 SE 7TH ST UNIT G-37
VANCOUVER WA
98683-6976
US

V. Phone/Fax

Practice location:
  • Phone: 360-433-6346
  • Fax:
Mailing address:
  • Phone: 503-341-3140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT00002309
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number977700
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: