Provider Demographics
NPI:1407412265
Name:COLEY-ENLOWE, MELISSA CAROLE (OT/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CAROLE
Last Name:COLEY-ENLOWE
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:C
Other - Last Name:ENLOWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT/L
Mailing Address - Street 1:4801 EDWARDS MILL RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4417
Mailing Address - Country:US
Mailing Address - Phone:919-787-0777
Mailing Address - Fax:919-787-0615
Practice Address - Street 1:4801 EDWARDS MILL RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4417
Practice Address - Country:US
Practice Address - Phone:919-787-0777
Practice Address - Fax:919-787-0615
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2128225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist