Provider Demographics
NPI:1619273141
Name:CORDELL, MELISSA ELAINE (MOTR)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ELAINE
Last Name:CORDELL
Suffix:
Gender:F
Credentials:MOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 SE 22ND PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8221
Mailing Address - Country:US
Mailing Address - Phone:920-946-3594
Mailing Address - Fax:
Practice Address - Street 1:2416 SE 22ND PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8221
Practice Address - Country:US
Practice Address - Phone:920-946-3594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4865-026225X00000X
FLOT14808225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist