Provider Demographics
NPI:1124465273
Name:REITER, MELONIE DAWN (MOTR/L)
Entity type:Individual
Prefix:MRS
First Name:MELONIE
Middle Name:DAWN
Last Name:REITER
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:MS
Other - First Name:MELONIE
Other - Middle Name:DAWN
Other - Last Name:STEPHENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5901 ERMEMIN AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5996
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5901 ERMEMIN AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5996
Practice Address - Country:US
Practice Address - Phone:505-219-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3029225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist