Provider Demographics
NPI:1548538721
Name:LYNCH, MELISSA LYNN (COTA/L)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:LYNCH
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 1:1019 HIPP RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-1578
Mailing Address - Country:US
Mailing Address - Phone:704-942-0472
Mailing Address - Fax:
Practice Address - Street 1:1019 HIPP RD
Practice Address - Street 2:SUITE 108
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-1578
Practice Address - Country:US
Practice Address - Phone:704-942-0472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP003399L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant