Provider Demographics
NPI:1922234947
Name:HERLONG, MELISSA CRIBB (OTR/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CRIBB
Last Name:HERLONG
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 1:339 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-8035
Mailing Address - Country:US
Mailing Address - Phone:843-423-3880
Mailing Address - Fax:
Practice Address - Street 1:520 FRANCIS MARION RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-4701
Practice Address - Country:US
Practice Address - Phone:843-661-1815
Practice Address - Fax:843-669-3393
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1547225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist