Provider Demographics
NPI:1982209771
Name:CONKLIN, MELINDA LEE (OT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:LEE
Last Name:CONKLIN
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 1:1220 CROZET AVE
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-3163
Mailing Address - Country:US
Mailing Address - Phone:434-823-4307
Mailing Address - Fax:
Practice Address - Street 1:1220 CROZET AVE
Practice Address - Street 2:
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-3163
Practice Address - Country:US
Practice Address - Phone:434-823-4307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119001517225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology