Provider Demographics
NPI:1154324788
Name:MATTEO-POMPOCO, MELISSA M (OT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:M
Last Name:MATTEO-POMPOCO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6470 TIPPECANOE RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9008
Mailing Address - Country:US
Mailing Address - Phone:330-729-2737
Mailing Address - Fax:330-729-2742
Practice Address - Street 1:6470 TIPPECANOE RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9008
Practice Address - Country:US
Practice Address - Phone:330-729-2737
Practice Address - Fax:330-729-2742
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-04968225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOT-04968OtherLICENSE
OH4104181Medicare ID - Type Unspecified