Provider Demographics
NPI:1942538236
Name:BERROUARD, MELINDA J (PTA,COTA/L)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:J
Last Name:BERROUARD
Suffix:
Gender:F
Credentials:PTA,COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-1629
Mailing Address - Country:US
Mailing Address - Phone:603-358-3384
Mailing Address - Fax:603-358-6485
Practice Address - Street 1:91 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-1629
Practice Address - Country:US
Practice Address - Phone:603-358-3384
Practice Address - Fax:603-358-6485
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0457224Z00000X
NH0737225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant