Provider Demographics
NPI:1689089260
Name:WYSKIEL, MELISSA LYN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYN
Last Name:WYSKIEL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 EDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06455-1219
Mailing Address - Country:US
Mailing Address - Phone:860-759-0076
Mailing Address - Fax:
Practice Address - Street 1:534 TOWN ST
Practice Address - Street 2:
Practice Address - City:EAST HADDAM
Practice Address - State:CT
Practice Address - Zip Code:06423-1390
Practice Address - Country:US
Practice Address - Phone:860-873-6547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004157225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist