Provider Demographics
NPI:1073215844
Name:YAMSUAN, MELROSE MATIAS (OTR/L)
Entity Type:Individual
Prefix:
First Name:MELROSE
Middle Name:MATIAS
Last Name:YAMSUAN
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 1:583 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-3397
Mailing Address - Country:US
Mailing Address - Phone:818-736-1000
Mailing Address - Fax:
Practice Address - Street 1:215 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2312
Practice Address - Country:US
Practice Address - Phone:559-459-1842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23373225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist