Provider Demographics
NPI:1538524954
Name:DAVIS, MELISSA (MS OTR/L)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 RHEDIA LN
Mailing Address - Street 2:
Mailing Address - City:HUGHESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17737-8363
Mailing Address - Country:US
Mailing Address - Phone:570-505-9146
Mailing Address - Fax:
Practice Address - Street 1:276 RHEDIA LN
Practice Address - Street 2:
Practice Address - City:HUGHESVILLE
Practice Address - State:PA
Practice Address - Zip Code:17737-8363
Practice Address - Country:US
Practice Address - Phone:570-505-9146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC0070115L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist