Basic Information
| Provider Information | |||||||||
| NPI: | 1780705764 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KURRUS | ||||||||
| FirstName: | MELINDA | ||||||||
| MiddleName: | BLAIR | ||||||||
| NamePrefix: | |||||||||
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| Credential: | OTR | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WELCH | ||||||||
| OtherFirstName: | MELINDA | ||||||||
| OtherMiddleName: | BLAIR | ||||||||
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| OtherCredential: | OTR | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2605 E CREEKS EDGE DR | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474018368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123332663 | ||||||||
| FaxNumber: | 8126764131 | ||||||||
| Practice Location | |||||||||
| Address1: | 1375 N WELLNESS WAY | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474049786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123556933 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 08/15/2019 | ||||||||
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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 | 31004096A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.