Provider Demographics
NPI:1407081870
Name:GILLIS, MELISSA POZZA (OT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:POZZA
Last Name:GILLIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:POZZA
Other - Last Name:KUTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT
Mailing Address - Street 1:118 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1677
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11 FLOWERS DR STE 101
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1714
Practice Address - Country:US
Practice Address - Phone:717-691-8300
Practice Address - Fax:717-691-8399
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC001325L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist