MEDICARE: MS. MELISSA MARIE FREY OTR/L

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
1	225XP0200X	Pediatric Occupational Therapist	011454-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083925754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA MARIE FREY OTR/L

Provider Business Mailing Address
First Line	:	61 GRAYWOOD RD
Second Line	:
City	:	PORT WASHINGTON
State	:	NY
Zip	:	11050-1537
Country	:	US
Telephone Number	:	516-424-1688
Fax Number	:

Provider Business Practice Location Address
First Line	:	361 E 19TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-2888
Country	:	US
Telephone Number	:	212-721-5220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	07/14/2010

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