Provider Demographics
NPI:1144306929
Name:NORTHUP, MELANIE K (OTR)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:K
Last Name:NORTHUP
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-3920
Mailing Address - Country:US
Mailing Address - Phone:970-521-0395
Mailing Address - Fax:
Practice Address - Street 1:427 W MAIN ST
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-3033
Practice Address - Country:US
Practice Address - Phone:970-522-7743
Practice Address - Fax:970-522-8835
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAA248682225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO066589Medicare ID - Type Unspecified