Provider Demographics
NPI:1730657578
Name:COLON, MELISSA MARIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIA
Last Name:COLON
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 1:1061 SAINT NICHOLAS AVE APT 54
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3817
Mailing Address - Country:US
Mailing Address - Phone:917-232-7054
Mailing Address - Fax:
Practice Address - Street 1:8 BEACH ST FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2483
Practice Address - Country:US
Practice Address - Phone:212-608-9661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022917-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics