Provider Demographics
NPI:1437692852
Name:GREENLAW, MELISSA DIANE (MELISSA GREENLAW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DIANE
Last Name:GREENLAW
Suffix:
Gender:F
Credentials:MELISSA GREENLAW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:GREENLAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:12 WINTHROP CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-2724
Mailing Address - Country:US
Mailing Address - Phone:978-987-6566
Mailing Address - Fax:
Practice Address - Street 1:365 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4700
Practice Address - Country:US
Practice Address - Phone:860-442-0711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3932225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist