Healthcare Provider Details

I. General information

NPI: 1255581781
Provider Name (Legal Business Name): MELISSA DEPODESTA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2008
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 N MAIN ST STE 2B
SOUTHINGTON CT
06489-2577
US

IV. Provider business mailing address

132 CARMALT RD
HAMDEN CT
06517-1904
US

V. Phone/Fax

Practice location:
  • Phone: 860-402-1607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number002564
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: