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NPI Code Detail

MEDICARE: MELISSA JANE MACLELLAN OTR

MEDICARE: MELISSA JANE MACLELLAN OTR
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
1225X00000XOccupational Therapist4337NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1127GYOTHERNCBCBSNC
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710044326
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA JANE MACLELLAN OTR
Provider Business Mailing Address
First Line : 217 S TREMONT DR
Second Line :
City : GREENSBORO
State : NC
Zip : 27403-1736
Country : US
Telephone Number : 336-275-7026
Fax Number :
Provider Business Practice Location Address
First Line : 2300 SPRING GARDEN ST
Second Line :
City : GREENSBORO
State : NC
Zip : 27403-2135
Country : US
Telephone Number : 336-294-3338
Fax Number : 336-294-6696
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2007
Last Update Date : 07/09/2007

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