Basic Information
| Provider Information | |||||||||
| NPI: | 1972735538 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUDDETH | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4390 BELLE OAKS DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294058559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665712700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4390 BELLE OAKS DR | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294058559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665712700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2009 | ||||||||
| LastUpdateDate: | 08/17/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 1555 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.