Provider Demographics
NPI:1154534956
Name:MINER, MELINDA GAIL (COTA)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:GAIL
Last Name:MINER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 ARBOR KNOLL BLVD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-5394
Mailing Address - Country:US
Mailing Address - Phone:615-739-5973
Mailing Address - Fax:
Practice Address - Street 1:211 COOL SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-7242
Practice Address - Country:US
Practice Address - Phone:615-778-6835
Practice Address - Fax:615-778-6797
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0099224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant