Individual
JILL MELLOTT
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
202 CARSON AVE, ALAMOSA, CO 81101-2342
(719) 589-5149
(719) 589-3717
Mailing address
202 CARSON AVE, ALAMOSA, CO 81101-2342
(719) 589-5149
(719) 589-3717
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
1009493
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
840706945104
ROCKY MOUNTAIN HEALTH PLA
CO
01
—
CE654889
ANTHEM BCBS
CO
Enumeration date
10/26/2005
Last updated
07/08/2007
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