Provider Demographics
NPI:1124238969
Name:MOE, MELONEE STARR (PT)
Entity type:Individual
Prefix:MRS
First Name:MELONEE
Middle Name:STARR
Last Name:MOE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11518 S LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-2209
Mailing Address - Country:US
Mailing Address - Phone:918-298-0033
Mailing Address - Fax:
Practice Address - Street 1:11518 S LOCUST AVE
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-2209
Practice Address - Country:US
Practice Address - Phone:918-298-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT1739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist