Provider Demographics
NPI:1528293024
Name:STIREWALT, MELISSA ROSE (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ROSE
Last Name:STIREWALT
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 DAN HALES DR
Mailing Address - Street 2:
Mailing Address - City:ATKINSON
Mailing Address - State:NC
Mailing Address - Zip Code:28421-9265
Mailing Address - Country:US
Mailing Address - Phone:910-231-8839
Mailing Address - Fax:
Practice Address - Street 1:54 DAN HALES DR
Practice Address - Street 2:
Practice Address - City:ATKINSON
Practice Address - State:NC
Practice Address - Zip Code:28421-9265
Practice Address - Country:US
Practice Address - Phone:910-231-8839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6999224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant