Provider Demographics
NPI:1144522632
Name:RHODUS, MELISSA (OTR/L)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:RHODUS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12930 JOSHUA DR
Mailing Address - Street 2:
Mailing Address - City:CHAFFEE
Mailing Address - State:NY
Mailing Address - Zip Code:14030-9818
Mailing Address - Country:US
Mailing Address - Phone:716-998-4348
Mailing Address - Fax:
Practice Address - Street 1:12930 JOSHUA DR
Practice Address - Street 2:
Practice Address - City:CHAFFEE
Practice Address - State:NY
Practice Address - Zip Code:14030-9818
Practice Address - Country:US
Practice Address - Phone:716-998-4348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011023-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist