Provider Demographics
NPI:1053882977
Name:FELDMAN, MELISSA IRENE (MED, OTR/L)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:IRENE
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:MED, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 DYER AVE
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-1511
Mailing Address - Country:US
Mailing Address - Phone:617-653-0080
Mailing Address - Fax:
Practice Address - Street 1:83 DYER AVE
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-1511
Practice Address - Country:US
Practice Address - Phone:617-653-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7758225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics