Provider Demographics
NPI:1629663299
Name:MELVIN, ABIGAIL LYNN (ODT)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LYNN
Last Name:MELVIN
Suffix:
Gender:F
Credentials:ODT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8961 S SWAN CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1717
Mailing Address - Country:US
Mailing Address - Phone:513-509-3743
Mailing Address - Fax:
Practice Address - Street 1:6180 HIGHWAY MM
Practice Address - Street 2:
Practice Address - City:HOUSE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:63051-2315
Practice Address - Country:US
Practice Address - Phone:636-671-3382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021007751225X00000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist