Basic Information
| Provider Information | |||||||||
| NPI: | 1073718003 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEVERSON | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | OTR/L | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MUNTER | ||||||||
| OtherFirstName: | MELISSA | ||||||||
| OtherMiddleName: | D | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 540 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT ANGEL | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973629540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038452736 | ||||||||
| FaxNumber: | 5038459229 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT ANGEL | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973629540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038452736 | ||||||||
| FaxNumber: | 5038459229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 02/14/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 229635 | OR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.