Provider Demographics
NPI:1316992308
Name:JOHNKE, MELANIE LYNN (OTR/L, CHT)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:LYNN
Last Name:JOHNKE
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 CALIFORNIA STREET
Mailing Address - Street 2:SUITE 450
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109
Mailing Address - Country:US
Mailing Address - Phone:415-359-1444
Mailing Address - Fax:415-447-3868
Practice Address - Street 1:1700 CALIFORNIA ST.
Practice Address - Street 2:SUITE 450
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109
Practice Address - Country:US
Practice Address - Phone:415-359-1444
Practice Address - Fax:415-447-3868
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1231225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
6442930001Medicare NSC