Provider Demographics
NPI:1114123825
Name:DUNNIWAY, MELANIE AQUINO (OTR)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:AQUINO
Last Name:DUNNIWAY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 MARY ALICE WAY
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377
Mailing Address - Country:US
Mailing Address - Phone:209-603-0716
Mailing Address - Fax:209-836-0817
Practice Address - Street 1:2160 MARY ALICE WAY
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-2264
Practice Address - Country:US
Practice Address - Phone:209-603-0716
Practice Address - Fax:209-836-0817
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA997540225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist