Provider Demographics
NPI:1780403147
Name:PALMACCIO, MELANIE MARLENE (COTA)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:MARLENE
Last Name:PALMACCIO
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 1:130 MONTAUK HWY UNIT F
Mailing Address - Street 2:
Mailing Address - City:EAST MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11940-1153
Mailing Address - Country:US
Mailing Address - Phone:631-874-0571
Mailing Address - Fax:
Practice Address - Street 1:130 MONTAUK HWY UNIT F
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940-1153
Practice Address - Country:US
Practice Address - Phone:631-874-0571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY519669224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant