Healthcare Provider Details

I. General information

NPI: 1144513342
Provider Name (Legal Business Name): MELISSA N HAUTALA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA DEETS

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6276 PARKVIEW RD
GREENDALE WI
53129-2150
US

IV. Provider business mailing address

6276 PARKVIEW RD
GREENDALE WI
53129-2150
US

V. Phone/Fax

Practice location:
  • Phone: 920-213-6158
  • Fax:
Mailing address:
  • Phone: 920-213-6158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number056.008947
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number5190-26
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: