Melinda Raquel Mickelsen, MS, ORT/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

KY-R1598 Issued in KY

Practice address

304 Lancassange Dr
Jeffersonville, IN 47130-5454

Phone

(502) 645-0564

NPI assigned

Aug 22, 2008

Last updated

Aug 22, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1219363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219363200000",
    "number": "1720235690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 LANCASSANGE DR",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471305454",
            "telephone_number": "502-645-0564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 LANCASSANGE DR",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "471305454",
            "telephone_number": "502-645-0564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKELSEN",
        "first_name": "MELINDA",
        "middle_name": "RAQUEL",
        "name_prefix": "Ms.",
        "credential": "MS, ORT/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-08-22",
        "last_updated": "2008-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "KY",
            "license": "KY-R1598",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IN",
            "license": "31004140A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Occupational Therapist in Jeffersonville, IN
• Providers in Jeffersonville, IN by specialty
• Occupational Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2008; 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.