Provider Demographics
NPI:1417499203
Name:DELATORRE, MELISSA LEE (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEE
Last Name:DELATORRE
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LEE
Other - Last Name:LARSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:644 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3431
Mailing Address - Country:US
Mailing Address - Phone:201-264-6264
Mailing Address - Fax:
Practice Address - Street 1:644 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3431
Practice Address - Country:US
Practice Address - Phone:201-264-6264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00526900225XF0002X, 225XN1300X, 225XP0019X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation