Provider Demographics
NPI:1225574437
Name:MELNYK, JASON (OTR/L,MS, CEAS II)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:MELNYK
Suffix:
Gender:M
Credentials:OTR/L,MS, CEAS II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 MARNE HWY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3126
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 E GATE DR
Practice Address - Street 2:SUITE 304
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-3838
Practice Address - Country:US
Practice Address - Phone:856-677-4000
Practice Address - Fax:856-234-3014
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00762300225X00000X
PAOC008432225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist