Provider Demographics
NPI:1336552843
Name:BAMBERGER, MELANIE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:BAMBERGER
Suffix:
Gender:F
Credentials: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:PO BOX 1312
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-7312
Mailing Address - Country:US
Mailing Address - Phone:631-874-0571
Mailing Address - Fax:631-878-0527
Practice Address - Street 1:377 MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3524
Practice Address - Country:US
Practice Address - Phone:631-874-0571
Practice Address - Fax:631-878-0527
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008399224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant