Provider Demographics
NPI:1780144337
Name:ERCOLINO, MELISSA DANIELLE (MOT, OTR/L)
Entity type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:DANIELLE
Last Name:ERCOLINO
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WINDSOR RD
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3411
Mailing Address - Country:US
Mailing Address - Phone:845-392-6946
Mailing Address - Fax:
Practice Address - Street 1:10 HASTINGS DR
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-2055
Practice Address - Country:US
Practice Address - Phone:845-440-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022369-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist