Provider Demographics
NPI:1891034468
Name:ANDERSON, MELINDA ANNE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:ANNE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 MAITLAND SUMMIT BLVD APT 453
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-7228
Mailing Address - Country:US
Mailing Address - Phone:407-620-5746
Mailing Address - Fax:
Practice Address - Street 1:8700 MAITLAND SUMMIT BLVD APT 453
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-7228
Practice Address - Country:US
Practice Address - Phone:407-620-5746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA9517224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant