Basic Information
| Provider Information | |||||||||
| NPI: | 1578634879 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRANDAW | ||||||||
| FirstName: | MELINDA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 218 | ||||||||
| Address2: | |||||||||
| City: | OSCEOLA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540200218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152942111 | ||||||||
| FaxNumber: | 7152945758 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 65TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | OSCEOLA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540204370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7152942111 | ||||||||
| FaxNumber: | 7152945758 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2006 | ||||||||
| LastUpdateDate: | 03/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 4827-26 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 100675 | MN | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.