Provider Demographics
NPI:1184850224
Name:MORIARTY, MELISSA (MA,OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:MA,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-1208
Mailing Address - Country:US
Mailing Address - Phone:516-220-3120
Mailing Address - Fax:
Practice Address - Street 1:34 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-1208
Practice Address - Country:US
Practice Address - Phone:516-220-3120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007148-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist