Provider Demographics
NPI:1962546531
Name:SOUDEN, MELISSA GAYLE (OTR L)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GAYLE
Last Name:SOUDEN
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 1:858 W ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-5917
Mailing Address - Country:US
Mailing Address - Phone:847-991-3528
Mailing Address - Fax:
Practice Address - Street 1:858 W ELLIS ST
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-5917
Practice Address - Country:US
Practice Address - Phone:847-991-3528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist