Provider Demographics
NPI:1427232370
Name:SMALL, MELINDA JEAN (OT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:JEAN
Last Name:SMALL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 HUSKA RD
Mailing Address - Street 2:
Mailing Address - City:DELANCEY
Mailing Address - State:NY
Mailing Address - Zip Code:13752-2139
Mailing Address - Country:US
Mailing Address - Phone:607-237-1835
Mailing Address - Fax:
Practice Address - Street 1:1518 HUSKA RD
Practice Address - Street 2:
Practice Address - City:DELANCEY
Practice Address - State:NY
Practice Address - Zip Code:13752-2139
Practice Address - Country:US
Practice Address - Phone:607-237-1835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2013-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012217-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist