Provider Demographics
NPI:1083855647
Name:MELNIKOVA, VICTORIA (OT)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:MELNIKOVA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5334 LINDLEY AVE UNIT 109
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2907
Mailing Address - Country:US
Mailing Address - Phone:323-449-5577
Mailing Address - Fax:
Practice Address - Street 1:505 SHATTO PL STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1777
Practice Address - Country:US
Practice Address - Phone:213-736-0450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2692225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist