Provider Demographics
NPI:1659492353
Name:MORRISON RIDDLE, MELANIE (OTRL)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MORRISON RIDDLE
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06029-4212
Mailing Address - Country:US
Mailing Address - Phone:860-896-1300
Mailing Address - Fax:
Practice Address - Street 1:22 SOUTH ST
Practice Address - Street 2:
Practice Address - City:VERNON ROCKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06066-4553
Practice Address - Country:US
Practice Address - Phone:860-875-0771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003211225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist