Provider Demographics
NPI:1144515602
Name:MILFORD, MELISSA JEAN (OT)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JEAN
Last Name:MILFORD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:JEAN
Other - Last Name:PLOEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2 HARBOR BEND CT. SUITE 102
Mailing Address - Street 2:
Mailing Address - City:LAKE ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367
Mailing Address - Country:US
Mailing Address - Phone:636-695-2070
Mailing Address - Fax:636-695-2080
Practice Address - Street 1:100 MEDICAL PLAZA DRIVE
Practice Address - Street 2:ATTN: PHYSICAL THERAPY
Practice Address - City:LAKE ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367
Practice Address - Country:US
Practice Address - Phone:630-625-7749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000162056225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation