Provider Demographics
NPI:1881068526
Name:MELITO, JAIME WAICUS (OTR/L)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:WAICUS
Last Name:MELITO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 FOXHALL RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28570-6790
Mailing Address - Country:US
Mailing Address - Phone:252-223-2560
Mailing Address - Fax:
Practice Address - Street 1:210 FOXHALL RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NC
Practice Address - Zip Code:28570-6790
Practice Address - Country:US
Practice Address - Phone:252-223-2560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-18
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003878225X00000X
NC15372225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist