Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT60061027 | WA |
NPI | 1043218332 |
---|---|
Provider Name | Melanie A Ford |
First Address | Colville, WA 99114 |
Second Address | Silver City, NM 88061-6502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 17/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17955866 | (05) | NM |