Individual
VICKI MELLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
5000 FAIRBANKS AVE, ALEXANDRIA, VA 22311-1246
(202) 779-2204
Mailing address
5000 FAIRBANKS AVE, ALEXANDRIA, VA 22311-1246
(202) 779-2204
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131001509
VA
Other
Enumeration date
04/29/2016
Last updated
04/29/2016
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