Provider Demographics
NPI:1508047945
Name:MELVILLE, GABRIELE (OTL CLT LANA)
Entity Type:Individual
Prefix:
First Name:GABRIELE
Middle Name:
Last Name:MELVILLE
Suffix:
Gender:F
Credentials:OTL CLT LANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 DAIRYLAND RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-5640
Mailing Address - Country:US
Mailing Address - Phone:919-933-5068
Mailing Address - Fax:919-967-1705
Practice Address - Street 1:1829 E FRANKLIN ST STE 200A
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1866
Practice Address - Country:US
Practice Address - Phone:919-619-3490
Practice Address - Fax:919-967-1705
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3074174400000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2504172Medicare PIN