MEDICARE: MELISSA B RYAN

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
1	225X00000X	Occupational Therapist	31005422A	IN
2	225XP0200X	Pediatric Occupational Therapist	OT009291	OH
3	225X00000X	Occupational Therapist	6790	WI

General Provider Information

NPI Number	:	1477891133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA B RYAN

Provider Business Mailing Address
First Line	:	2251 N SHORE DR
Second Line	:
City	:	RHINELANDER
State	:	WI
Zip	:	54501-6710
Country	:	US
Telephone Number	:	715-361-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	3430 BURNET AVE # 4007
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-2833
Country	:	US
Telephone Number	:	513-636-6020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2013
Last Update Date	:	10/28/2020

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Directions to “ MELISSA B RYAN ” Practice Location

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