Provider Demographics
NPI:1164962742
Name:BAYONNE, MELINDA S (OT)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:S
Last Name:BAYONNE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:MELINDA
Other - Middle Name:MARIE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:224 PECAN PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3308
Mailing Address - Country:US
Mailing Address - Phone:318-427-7852
Mailing Address - Fax:318-443-5372
Practice Address - Street 1:224 PECAN PARK AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3308
Practice Address - Country:US
Practice Address - Phone:318-427-7852
Practice Address - Fax:318-443-5372
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOTT.Z11192225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist