Provider Demographics
NPI:1962584672
Name:ROSEN, MELINDA JOY (OTR)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:JOY
Last Name:ROSEN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:MELINDA
Other - Middle Name:JOY
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OTR OTRC
Mailing Address - Street 1:94 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031
Mailing Address - Country:US
Mailing Address - Phone:603-886-0579
Mailing Address - Fax:603-886-0163
Practice Address - Street 1:1 BAYSIDE RD # 2
Practice Address - Street 2:
Practice Address - City:GREENLAND
Practice Address - State:NH
Practice Address - Zip Code:03840-2117
Practice Address - Country:US
Practice Address - Phone:603-373-0014
Practice Address - Fax:603-433-6787
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH020377315OtherCOMM TAX ID
NH561822OtherAETNA
NH272746OtherCIGNA
NH626514OtherHARVARD PILGRIM
NH761242OtherTUFTS
NH272746OtherCIGNA