Healthcare Provider Details

I. General information

NPI: 1932226875
Provider Name (Legal Business Name): MELISSA JO MASCIOLI OTR L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 SAVAGE RD STE 400C
CHARLESTON SC
29407-4791
US

IV. Provider business mailing address

208 FAIR OAKS DR
FAIRMONT WV
26554-9769
US

V. Phone/Fax

Practice location:
  • Phone: 843-571-2700
  • Fax:
Mailing address:
  • Phone: 304-288-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3069
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: