Individual
HOLLY JANELLEN MELLOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
9455 W WATERTOWN PLANK RD, MILWAUKEE, WI 53226-3559
(414) 257-6995
Mailing address
9455 W WATERTOWN PLANK RD, MILWAUKEE, WI 53226-3559
(414) 257-6995
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
538-26
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40646500
—
WI
01
—
AA217430
NBCOT
—
Enumeration date
05/13/2008
Last updated
05/13/2008
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