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NPI Code Detail

MEDICARE: MELLISSA MARY NOONAN OTR

MEDICARE: MELLISSA MARY NOONAN OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist004025CT

General Provider Information

NPI Number : 1053652248
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELLISSA MARY NOONAN OTR
Provider Business Mailing Address
First Line : 117 WAYLAND AVE
Second Line :
City : WATERBURY
State : CT
Zip : 06708-2190
Country : US
Telephone Number : 203-879-8066
Fax Number :
Provider Business Practice Location Address
First Line : 50 BEACH RD
Second Line :
City : WOLCOTT
State : CT
Zip : 06716-1902
Country : US
Telephone Number : 203-879-8066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2013
Last Update Date : 03/13/2013

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Directions to “ MELLISSA MARY NOONAN OTR” Practice Location

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