Provider Demographics
NPI:1932226875
Name:MASCIOLI, MELISSA JO (OTR L)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JO
Last Name:MASCIOLI
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 1:208 FAIR OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-9769
Mailing Address - Country:US
Mailing Address - Phone:304-288-1003
Mailing Address - Fax:
Practice Address - Street 1:1941 SAVAGE RD STE 400C
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4791
Practice Address - Country:US
Practice Address - Phone:843-571-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3069225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist