Provider Demographics
NPI:1649440298
Name:DEW, MELISSA WILLIAMS (COTA/L)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:WILLIAMS
Last Name:DEW
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 1:6311 COUNTY ROAD 747
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-8908
Mailing Address - Country:US
Mailing Address - Phone:256-338-4249
Mailing Address - Fax:
Practice Address - Street 1:6311 COUNTY ROAD 747
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-8908
Practice Address - Country:US
Practice Address - Phone:256-338-4249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2345224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant