Provider Demographics
NPI:1285810275
Name:KOESTERICH, MELISSA ROSE
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ROSE
Last Name:KOESTERICH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:ROSE
Other - Last Name:KOESTERICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR/L
Mailing Address - Street 1:60 SACHEM ST
Mailing Address - Street 2:
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821-5113
Mailing Address - Country:US
Mailing Address - Phone:978-670-7302
Mailing Address - Fax:
Practice Address - Street 1:60 SACHEM ST
Practice Address - Street 2:
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821-5113
Practice Address - Country:US
Practice Address - Phone:978-670-7302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4018225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics