Provider Demographics
NPI:1144907478
Name:MELONE, EMILY (COTA/L)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MELONE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 BROAD BRANCH CIRCLE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238
Mailing Address - Country:US
Mailing Address - Phone:862-258-5491
Mailing Address - Fax:
Practice Address - Street 1:3404 BROAD BRANCH CIR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-6465
Practice Address - Country:US
Practice Address - Phone:862-258-5491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA46TA09152900224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant