Provider Demographics
NPI:1972476943
Name:COUGHENOUR, MELANIE MARIE (COTA/L)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:MARIE
Last Name:COUGHENOUR
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 1:6209 E 25TH LN
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-1141
Mailing Address - Country:US
Mailing Address - Phone:217-369-4228
Mailing Address - Fax:
Practice Address - Street 1:6209 E 25TH LN
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-1141
Practice Address - Country:US
Practice Address - Phone:217-369-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4347224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant