Provider Demographics
NPI:1174814768
Name:DVORAK, MELANIE ANGELITA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ANGELITA
Last Name:DVORAK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:ANGELITA
Other - Last Name:CURET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:610 N DARR AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4635
Mailing Address - Country:US
Mailing Address - Phone:308-382-2635
Mailing Address - Fax:308-382-0418
Practice Address - Street 1:610 N DARR AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4635
Practice Address - Country:US
Practice Address - Phone:308-382-2635
Practice Address - Fax:308-382-0418
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE890225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist