Provider Demographics
NPI:1871057505
Name:ATKINSON, MELVIN DWIGHT JR (COTA)
Entity type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:DWIGHT
Last Name:ATKINSON
Suffix:JR
Gender:M
Credentials:COTA
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Mailing Address - Street 1:2536 BLOSSOM TRL W
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-4951
Mailing Address - Country:US
Mailing Address - Phone:540-520-2234
Mailing Address - Fax:
Practice Address - Street 1:2387 WARM HEARTH DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6281
Practice Address - Country:US
Practice Address - Phone:540-552-9176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131000769224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant