Provider Demographics
NPI:1255350880
Name:COLEMAN, MELINDA L (OTR/L)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:L
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 WALDEN GLEN LN
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3144
Mailing Address - Country:US
Mailing Address - Phone:706-495-2528
Mailing Address - Fax:706-364-0351
Practice Address - Street 1:815 WALDEN GLEN LN
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3144
Practice Address - Country:US
Practice Address - Phone:706-495-2528
Practice Address - Fax:706-364-0351
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003551225X00000X
SC2630225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA39219899AMedicaid