Individual
MARY JANE MELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,OTR/L
Contact information
Practice address
520 S EAGLE RD, MERIDIAN, ID 83642-6351
(208) 706-5000
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1875
ID
225X00000X
Occupational Therapist
OT1945
CA
Other
Enumeration date
07/17/2018
Last updated
07/17/2018
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