Provider Demographics
NPI:1427119304
Name:THOMPSON, MELANIE IRENE (OTR/L)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:IRENE
Last Name:THOMPSON
Suffix:
Gender:
Credentials:OTR/L
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:CONATSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25759 S 194TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6106
Mailing Address - Country:US
Mailing Address - Phone:602-793-9676
Mailing Address - Fax:
Practice Address - Street 1:108 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-5818
Practice Address - Country:US
Practice Address - Phone:480-688-1917
Practice Address - Fax:480-668-2750
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3009225XP0200X
AZOTH-003009225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ751190Medicaid