NPIMap

Individual provider Active NPI

Melanie L Jackson, MOTR/L, CHT

  • Hand Occupational Therapist
  • Lee's Summit, MO
National Provider Identifier
1174711550
Registry record updated Sep 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hand Occupational TherapistTaxonomy code 225XH1200X
License
2008014106 Issued in MO
Practice address
300 NE Missouri Rd
Lees Summit, MO 64086-4714
Phone
(816) 836-2500
Fax
(816) 836-2525
NPI assigned
Oct 10, 2007
Last updated
Sep 17, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 17-02390 KS
Hand Occupational Therapist 225XH1200X 2008014106 MO Primary

Addresses

Primary practice location

300 NE Missouri Rd
Lees Summit, MO 64086-4714

Mailing address

300 NE Missouri Rd
Lees Summit, MO 64086-4714
Phone (816) 836-2500

Other names 1

  • Melanie L Matzeder Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
17-02390KSMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Hand Therapy, Inc Hand Past Accepting new patients
Summit Hand Rehabilitation, LLC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410912000000",
    "number": "1174711550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 NE MISSOURI RD",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640864714",
            "telephone_number": "816-836-2500",
            "fax_number": "816-836-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 NE MISSOURI RD",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640864714",
            "telephone_number": "816-836-2500",
            "fax_number": "816-836-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MELANIE",
        "middle_name": "L",
        "credential": "MOTR/L, CHT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-10",
        "last_updated": "2014-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "KS",
            "license": "17-02390",
            "primary": false
        },
        {
            "code": "225XH1200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Hand",
            "state": "MO",
            "license": "2008014106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELANIE",
            "last_name": "MATZEDER",
            "middle_name": "L",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lee's Summit, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.