Provider Demographics
NPI:1386943397
Name:CRAYNE, MELISSA JANE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:JANE
Last Name:CRAYNE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-6040
Mailing Address - Country:US
Mailing Address - Phone:502-836-7088
Mailing Address - Fax:
Practice Address - Street 1:3607 OAKVISTA PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-8479
Practice Address - Country:US
Practice Address - Phone:502-836-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31003697A225X00000X
KYKY-R2937225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist