Provider Demographics
NPI:1215901459
Name:WILGUS, MELISSA (MS, ATC, CSCS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WILGUS
Suffix:
Gender:F
Credentials:MS, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4162 BERRYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5102
Mailing Address - Country:US
Mailing Address - Phone:614-428-8303
Mailing Address - Fax:
Practice Address - Street 1:479 PARSONS AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5577
Practice Address - Country:US
Practice Address - Phone:614-722-5577
Practice Address - Fax:614-722-5581
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT 10262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer