=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245140417
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA WALRAVEN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2026
-----------------------------------------------------
Last Update Date | 09/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6520 MERCANTILE WAY STE 1&2
-----------------------------------------------------
City | LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48911-6957
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-244-1430
-----------------------------------------------------
Fax | 517-272-1216
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2145 ASPENWOOD DR
-----------------------------------------------------
City | HOLT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48842-8725
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-203-8463
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 5201009402
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------