Provider Demographics
NPI:1437239266
Name:MELNIKOV, IVAN DARIO (OT/L)
Entity Type:Individual
Prefix:MR
First Name:IVAN
Middle Name:DARIO
Last Name:MELNIKOV
Suffix:
Gender:M
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8453
Mailing Address - Country:US
Mailing Address - Phone:919-460-1921
Mailing Address - Fax:919-460-1929
Practice Address - Street 1:1611 NW 12TH AVENUE
Practice Address - Street 2:OCCUPATIONAL THARAPY DEPARTMENT
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1096
Practice Address - Country:US
Practice Address - Phone:305-585-7224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13177225X00000X
FLOT8407225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist