Provider Demographics
NPI:1447722350
Name:MYERS, MELISSA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39814 CLAIRES DR
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659-5326
Mailing Address - Country:US
Mailing Address - Phone:410-818-8047
Mailing Address - Fax:
Practice Address - Street 1:23160 MOAKLEY ST
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2922
Practice Address - Country:US
Practice Address - Phone:301-475-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06478225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist