Provider Demographics
NPI:1548504939
Name:BLANCAFLOR, MELISSA A (MS, OT/L)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:A
Last Name:BLANCAFLOR
Suffix:
Gender:F
Credentials:MS, OT/L
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:REGENCIA
Other - Last Name:ABASTILLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OT/L
Mailing Address - Street 1:8956 LANDERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-1766
Mailing Address - Country:US
Mailing Address - Phone:703-339-6408
Mailing Address - Fax:
Practice Address - Street 1:7430 SPRING VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-4446
Practice Address - Country:US
Practice Address - Phone:703-923-4684
Practice Address - Fax:703-923-4681
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119003146225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist