Mellisa Fanning, OTD

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

2394 Issued in AL

Practice address

717 Marina Park Dr SE
Huntsville, AL 35803-3034

Phone

(256) 684-3368

NPI assigned

Jan 21, 2021

Last updated

Jan 21, 2021By 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

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Functional Pathways Preferred of Tennessee LLCGroup PAC ID 2860649654, 194 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Redstone Village

  dba Fairview At Redstone Village

  • Skilled Nursing Facility
  • Huntsville, AL
  • NPI 1992782973

  Operational/Managerial Control

  CMS ownership

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.

• Functional Pathways Preferred of Tennessee LLC

  • Physical Therapist
  • Knoxville, TN
  • NPI 1841561446

  AL, Occupational Therapist

  Medicare reassignment Care Compare group NPD
• Functional Pathways

  • Occupational Therapist
  • Huntsville, AL
  • NPI 1194214262
  NPD Authorized official

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

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1508456732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "717 MARINA PARK DR SE",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358033034",
            "telephone_number": "256-684-3368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 MARINA PARK DR SE",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358033034",
            "telephone_number": "256-684-3368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANNING",
        "first_name": "MELLISA",
        "credential": "OTD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-21",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "AL",
            "license": "2394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Medicine of Huntsville, PC
• Family Practice Center of Huntsville PC
• Family Services Center
• Family Services Center
• John Elliott Fanning, MD
• Sherry W Fanning, MS, CCC/SLP
• Faraday Alabama LLC (Faraday Alabama)
• Michel Farah, MD
• Madison Farkas
• Hailey Farmer, CRNP

• Occupational Therapist in Huntsville, AL
• Providers in Huntsville, AL by specialty
• Occupational Therapist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.