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General NPI Number Information
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NPI Number | 1659497188
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Entity Type | Individual
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Provider Name | MELISSA BEAULIEU OT
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 490 HIGHWAY 96 W SUITE 300
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City | SHOREVIEW
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State | MN
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Zip | 55126-1960
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Country | US
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Telephone | 651-451-3016
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Fax |
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Provider Business Mailing Address
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Address Line | 686 ARLINGTON AVE W
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City | SAINT PAUL
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State | MN
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Zip | 55117-4154
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Country | US
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Telephone | 651-489-0044
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 102868
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License Number State | MN
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