Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 31004326A | IN |
NPI | 1003078882 |
---|---|
Provider Name | Melisa Overstreet |
First Address | Corydon, IN 47112-1717 |
Second Address | Corydon, IN 47112-1717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 02/07/2008 |