Provider Demographics
NPI:1942533161
Name:MCGONIGLE, MELISSA A (OT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:MCGONIGLE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 BRANDYWINE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19809-2306
Mailing Address - Country:US
Mailing Address - Phone:302-529-3118
Mailing Address - Fax:302-454-5442
Practice Address - Street 1:200 TYRE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-7136
Practice Address - Country:US
Practice Address - Phone:302-454-2047
Practice Address - Fax:302-454-5442
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FMU2-0001137224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant