Provider Demographics
NPI:1235648478
Name:MELLO, MADELINE (OTD)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:
Last Name:MELLO
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:MADDIE
Other - Middle Name:
Other - Last Name:MELLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3285 SEBASTIAN LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1240
Mailing Address - Country:US
Mailing Address - Phone:781-500-9194
Mailing Address - Fax:
Practice Address - Street 1:3285 SEBASTIAN LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1240
Practice Address - Country:US
Practice Address - Phone:781-500-9194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist