Provider Demographics
NPI:1225658065
Name:O'HANLON, MELANIE NAZARENO
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:NAZARENO
Last Name:O'HANLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:MANDABON
Other - Last Name:NAZARENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 HORIZON DR STE 310
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4926
Mailing Address - Country:US
Mailing Address - Phone:919-424-5080
Mailing Address - Fax:
Practice Address - Street 1:110 HORIZON DR STE 310
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4926
Practice Address - Country:US
Practice Address - Phone:919-424-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040127225100000X
MO2020026343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist