Provider Demographics
NPI:1891048708
Name:BULKLEY, MELISSA JOAN (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JOAN
Last Name:BULKLEY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WISHING LN
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-6423
Mailing Address - Country:US
Mailing Address - Phone:516-579-6188
Mailing Address - Fax:
Practice Address - Street 1:18 WISHING LN
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-6423
Practice Address - Country:US
Practice Address - Phone:516-579-6188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017674225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist