Provider Demographics
NPI:1053866442
Name:MOUNT, MELINDA KAY (COTA/L)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:KAY
Last Name:MOUNT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:KAY
Other - Last Name:CALLAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:379 N BEAUMONT RD
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-7800
Mailing Address - Country:US
Mailing Address - Phone:423-762-9464
Mailing Address - Fax:
Practice Address - Street 1:8249 STANDIFER GAP RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-5046
Practice Address - Country:US
Practice Address - Phone:423-892-1716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2679224Z00000X
GAOTA002089224Z00000X
NC10470224Z00000X
TX214075224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant