Individual
MELISSA LORRAINE FENTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
1038 W JERICHO TPKE, SMITHTOWN, NY 11787-3208
(631) 368-2583
Mailing address
163 BROOK ST, BAY SHORE, NY 11706-5828
(631) 697-2573
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
027303
NY
Other
Enumeration date
10/11/2022
Last updated
10/11/2022
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