Provider Demographics
NPI:1659030039
Name:MELNECHUK, MYRIAN ELIZABETH (OT)
Entity Type:Individual
Prefix:
First Name:MYRIAN
Middle Name:ELIZABETH
Last Name:MELNECHUK
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 1:600 CENTRAL AVE APT 45
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-8503
Mailing Address - Country:US
Mailing Address - Phone:562-676-3845
Mailing Address - Fax:
Practice Address - Street 1:600 CENTRAL AVE APT 45
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-8503
Practice Address - Country:US
Practice Address - Phone:562-676-3845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist