Melissa Mattingly-Mardis, OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

R2253 Issued in KY

Practice address

991 Martin Rd
Campbellsville, KY 42718-9726

Phone

(270) 692-8826

Fax

(270) 789-6531

NPI assigned

Aug 6, 2007

Last updated

Aug 6, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Green River Occupational Therapy, LLC

  • Home Health Agency
  • Campbellsville, KY
  • NPI 1972794782
  NPD (past) Authorized official

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

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1186358400000",
    "number": "1316138134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "991 MARTIN RD",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427189726",
            "telephone_number": "270-692-8826",
            "fax_number": "270-789-6531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "991 MARTIN RD",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427189726",
            "telephone_number": "270-692-8826",
            "fax_number": "270-789-6531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATTINGLY-MARDIS",
        "first_name": "MELISSA",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-06",
        "last_updated": "2007-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "KY",
            "license": "R2253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST STEPS",
            "identifier": "01924",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monte Edward Martin, M.D.
• Tiffany Mascoe, LPCA
• Brianna Mason
• Lila Lee Masterson, ST
• John Harold Matthews, O.D.
• Amanda Lauren Mattingly, APRN
• Sean E Maynard, PA-C
• McCloud Inc. (The Ole Homeplace of Taylor County)
• Becky Jo McFee, PT
• Jessika McGuffin

• Pediatric Occupational Therapist in Campbellsville, KY
• Providers in Campbellsville, KY by specialty
• Pediatric Occupational Therapist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2007; 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.