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General NPI Number Information
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NPI Number | 1457603862
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Entity Type | Individual
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Provider Name | MELISSA WEST
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Gender | Female
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 519 8TH ST
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City | PARK HILLS
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State | MO
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Zip | 63601-4232
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Country | US
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Telephone | 573-431-3076
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Fax |
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Provider Business Mailing Address
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Address Line | 1049 DEERFIELD DR
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City | SULLIVAN
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State | MO
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Zip | 63080-1003
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2006032641
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License Number State | MO
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