Provider Demographics
NPI:1356648463
Name:HARRIS, MELONIE YVONNE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:MELONIE
Middle Name:YVONNE
Last Name:HARRIS
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 1:1903 LAIGH RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2628
Mailing Address - Country:US
Mailing Address - Phone:757-582-5212
Mailing Address - Fax:
Practice Address - Street 1:305 MARCELLA RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2433
Practice Address - Country:US
Practice Address - Phone:757-825-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-25
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000738224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant