Provider Demographics
NPI:1851582142
Name:MELTON, MICKEY HUGH (COTA)
Entity Type:Individual
Prefix:
First Name:MICKEY
Middle Name:HUGH
Last Name:MELTON
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:KY
Mailing Address - Zip Code:42327-0033
Mailing Address - Country:US
Mailing Address - Phone:270-543-8869
Mailing Address - Fax:270-684-4867
Practice Address - Street 1:2420 W 3RD ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-0328
Practice Address - Country:US
Practice Address - Phone:270-685-4705
Practice Address - Fax:270-684-4867
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY-A3420224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant