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NPI Code Detail

MEDICARE: MELISSA DARLENE MCKAIG OTR/L

MEDICARE: MELISSA DARLENE MCKAIG OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational Therapist2004022512MO
2225X00000XOccupational Therapist2004022512MO

General Provider Information

NPI Number : 1205033735
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA DARLENE MCKAIG OTR/L
Provider Business Mailing Address
First Line : 7836 SUN RIDGE CT
Second Line :
City : EDWARDSVILLE
State : IL
Zip : 62025-6464
Country : US
Telephone Number : 314-650-7005
Fax Number :
Provider Business Practice Location Address
First Line : 708 SAINT LOUIS ST
Second Line :
City : EDWARDSVILLE
State : IL
Zip : 62025-1427
Country : US
Telephone Number : 618-656-1182
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2007
Last Update Date : 10/03/2022

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