Provider Demographics
NPI:1568736759
Name:DEFERNELMONT, MELINDA (MOT, OTR/L, C/NDT)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:
Last Name:DEFERNELMONT
Suffix:
Gender:F
Credentials:MOT, OTR/L, C/NDT
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:FEESER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOT, OTR/L
Mailing Address - Street 1:261 WILDFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:EAST EARL
Mailing Address - State:PA
Mailing Address - Zip Code:17519-8805
Mailing Address - Country:US
Mailing Address - Phone:610-299-9312
Mailing Address - Fax:
Practice Address - Street 1:1623 MORGANTOWN RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19607-9455
Practice Address - Country:US
Practice Address - Phone:610-299-9312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC012186225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist