Provider Demographics
NPI:1255792578
Name:TONKAVICH, MELISSA (COTA/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:TONKAVICH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 COTTAGE TRL
Mailing Address - Street 2:
Mailing Address - City:EAST JORDAN
Mailing Address - State:MI
Mailing Address - Zip Code:49727-8652
Mailing Address - Country:US
Mailing Address - Phone:530-448-4381
Mailing Address - Fax:
Practice Address - Street 1:2780 CHARLEVOIX RD STE 15
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8058
Practice Address - Country:US
Practice Address - Phone:530-448-4381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOTA.0000684224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant