Healthcare Provider Details

I. General information

NPI: 1639488794
Provider Name (Legal Business Name): MELISSA DAS-GORDZIEJ OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA GORDZIEJ

II. Dates (important events)

Enumeration Date: 10/06/2010
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 N MEADE ST
APPLETON WI
54911-3454
US

IV. Provider business mailing address

3 NEENAH CTR
NEENAH WI
54956-3070
US

V. Phone/Fax

Practice location:
  • Phone: 920-729-2155
  • Fax: 920-720-7350
Mailing address:
  • Phone: 920-830-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number349526
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: