Provider Demographics
NPI:1447556725
Name:AVERY, MELISSA ELIZABETH (MSOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ELIZABETH
Last Name:AVERY
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 COLONEL LEDYARD HWY
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-1138
Mailing Address - Country:US
Mailing Address - Phone:860-536-0383
Mailing Address - Fax:
Practice Address - Street 1:265 COLONEL LEDYARD HWY
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-1138
Practice Address - Country:US
Practice Address - Phone:860-536-0383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001164224Z00000X
CT4088225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant