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NPI Code Detail

MEDICARE: MELISSA QUEEN BS, COTA/L

MEDICARE: MELISSA QUEEN BS, COTA/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
1224Z00000XOccupational Therapy AssistantOTA007888OH

General Provider Information

NPI Number : 1639000755
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA QUEEN BS, COTA/L
Provider Business Mailing Address
First Line : 6057 STRIP AVE NW
Second Line :
City : NORTH CANTON
State : OH
Zip : 44720-9207
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6057 STRIP AVE NW
Second Line :
City : NORTH CANTON
State : OH
Zip : 44720-9207
Country : US
Telephone Number : 330-492-8136
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2026
Last Update Date : 05/27/2026

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