Provider Demographics
NPI:1013285931
Name:LEVINE, MELISSA DANA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DANA
Last Name:LEVINE
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 1:295 ALPINE CIR
Mailing Address - Street 2:
Mailing Address - City:RIVERVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6164
Mailing Address - Country:US
Mailing Address - Phone:201-391-1319
Mailing Address - Fax:
Practice Address - Street 1:295 ALPINE CIR
Practice Address - Street 2:
Practice Address - City:RIVERVALE
Practice Address - State:NJ
Practice Address - Zip Code:07675-6164
Practice Address - Country:US
Practice Address - Phone:201-391-1319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008416-1225X00000X, 225XP0200X
NJ46TR00301300225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist