Provider Demographics
NPI:1972634657
Name:SCHILLO, MELISSA RUTH
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:RUTH
Last Name:SCHILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 782
Mailing Address - Street 2:
Mailing Address - City:BEACH
Mailing Address - State:ND
Mailing Address - Zip Code:58621-0782
Mailing Address - Country:US
Mailing Address - Phone:701-872-4810
Mailing Address - Fax:701-872-2304
Practice Address - Street 1:107 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5637
Practice Address - Country:US
Practice Address - Phone:701-227-3010
Practice Address - Fax:701-225-1968
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND134225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50361Medicaid