Provider Demographics
NPI:1366728370
Name:KOVACH, MELISSA JEAN (COTA)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JEAN
Last Name:KOVACH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:JEAN
Other - Last Name:ZAPP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:4560 SE INTERNATIONAL WAY
Mailing Address - Street 2:STE. 100
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:971-206-5200
Mailing Address - Fax:971-206-5203
Practice Address - Street 1:3959 SHERIDAN AVE.
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459
Practice Address - Country:US
Practice Address - Phone:541-756-4151
Practice Address - Fax:541-751-7715
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN200895224Z00000X
OR1009106224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant