Provider Demographics
NPI:1598971541
Name:MELVIN, NEIL TRAVIS (COTA)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:TRAVIS
Last Name:MELVIN
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 NEW HAMPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2244
Mailing Address - Country:US
Mailing Address - Phone:606-232-9367
Mailing Address - Fax:
Practice Address - Street 1:933 N TOLLIVER RD
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1347
Practice Address - Country:US
Practice Address - Phone:606-784-7518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY A2499224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant