Provider Demographics
NPI:1710651161
Name:PIETROSKI, MELISSA LEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEE
Last Name:PIETROSKI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SAINT PATRICK AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5157
Mailing Address - Country:US
Mailing Address - Phone:207-951-2511
Mailing Address - Fax:
Practice Address - Street 1:19 SAINT PATRICK AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5157
Practice Address - Country:US
Practice Address - Phone:207-951-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT3071225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist