Provider Demographics
NPI:1689736886
Name:FOX, MELINDA G (COTAL)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:G
Last Name:FOX
Suffix:
Gender:F
Credentials:COTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 COLFAX AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-3150
Mailing Address - Country:US
Mailing Address - Phone:763-560-3437
Mailing Address - Fax:
Practice Address - Street 1:1705 COPE AVE E
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2639
Practice Address - Country:US
Practice Address - Phone:651-773-0354
Practice Address - Fax:651-773-0371
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN200372224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant