Provider Demographics
NPI:1891144754
Name:GRANT, MELISSA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3137 STRATFORD CT
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2735
Mailing Address - Country:US
Mailing Address - Phone:703-865-5012
Mailing Address - Fax:
Practice Address - Street 1:3137 STRATFORD CT
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-2735
Practice Address - Country:US
Practice Address - Phone:703-865-5012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119004186225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist