=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508909789
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA K AHO MSPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 12/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 APPLETON RD
-----------------------------------------------------
City | MENASHA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54952-3727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-968-6234
-----------------------------------------------------
Fax | 920-725-2572
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1707 S NICOLET RD APT 2
-----------------------------------------------------
City | APPLETON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54914-7542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-730-9197
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number | 10018-024
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------