Provider Demographics
NPI:1154569937
Name:MCCULLEY, MELISSA J MORROW (CTRS, CPS TECH, WSI)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:J MORROW
Last Name:MCCULLEY
Suffix:
Gender:F
Credentials:CTRS, CPS TECH, WSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 NORTH AVE W
Mailing Address - Street 2:APT 2
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-5119
Mailing Address - Country:US
Mailing Address - Phone:732-258-7080
Mailing Address - Fax:
Practice Address - Street 1:200 SOMERSET ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1942
Practice Address - Country:US
Practice Address - Phone:732-258-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ51200225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist