Provider Demographics
NPI:1831605526
Name:EDLER, MELISSA (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:EDLER
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 1:114 WILLIAMS LN
Mailing Address - Street 2:
Mailing Address - City:JERSEY SHORE
Mailing Address - State:PA
Mailing Address - Zip Code:17740-8219
Mailing Address - Country:US
Mailing Address - Phone:570-398-4894
Mailing Address - Fax:
Practice Address - Street 1:2140 WARRENSVILLE RD
Practice Address - Street 2:
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-9621
Practice Address - Country:US
Practice Address - Phone:570-433-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP007480224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant