Provider Demographics
NPI:1710547047
Name:RAY, MELISSA CASSIDY
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CASSIDY
Last Name:RAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SOUTHSIDE RD
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1408
Mailing Address - Country:US
Mailing Address - Phone:978-762-4878
Mailing Address - Fax:
Practice Address - Street 1:1 SOUTHSIDE RD
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1408
Practice Address - Country:US
Practice Address - Phone:978-762-4878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist