Provider Demographics
NPI:1366604621
Name:GILLEN, MELISSA BURNLEY (OTR)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:BURNLEY
Last Name:GILLEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 SW 129TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1230
Mailing Address - Country:US
Mailing Address - Phone:305-223-8716
Mailing Address - Fax:305-223-8716
Practice Address - Street 1:4284 SW 161ST PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-3826
Practice Address - Country:US
Practice Address - Phone:305-228-6252
Practice Address - Fax:305-228-6251
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT13215225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist