| NPI | 1962663013 |
|---|---|
| Former Name | MELISSA GWEN MICKELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225XP0200X Occupational Therapist, Pediatrics (Licence: MO 2003024933) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: KS 17-02210) |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2008-06-20 |