Healthcare Provider Details

I. General information

NPI: 1033021613
Provider Name (Legal Business Name): MELANIE CHANDLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WASHINGTON ST. STE 1 #203
LODI NJ
07644-9998
US

IV. Provider business mailing address

25 WASHINGTON ST. STE 1 #203
LODI NJ
07644-9998
US

V. Phone/Fax

Practice location:
  • Phone: 646-651-0871
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number011856
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number46TA09243500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: