MEDICARE: MELISSA J CLIFFORD 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
1	225X00000X	Occupational Therapist	31003896A	IN

General Provider Information

NPI Number	:	1710151774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA J CLIFFORD OTR

Provider Business Mailing Address
First Line	:	3850 LAKE CLEARWATER PL
Second Line	:	APT 638
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-7736
Country	:	US
Telephone Number	:	317-833-3783
Fax Number	:	317-284-1186

Provider Business Practice Location Address
First Line	:	3850 LAKE CLEARWATER PL
Second Line	:	APT 638
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-7736
Country	:	US
Telephone Number	:	317-833-3783
Fax Number	:	317-284-1186

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

Provider Enumeration Date	:	04/21/2008
Last Update Date	:	04/21/2008

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