Provider Demographics
NPI:1548791825
Name:MCCANN, MELISSA
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:MCCANN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:SLOATSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10974-1601
Mailing Address - Country:US
Mailing Address - Phone:845-709-2056
Mailing Address - Fax:
Practice Address - Street 1:1 GRANT ST
Practice Address - Street 2:
Practice Address - City:SLOATSBURG
Practice Address - State:NY
Practice Address - Zip Code:10974-1601
Practice Address - Country:US
Practice Address - Phone:845-709-2056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005380-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant