Provider Demographics
NPI:1942817747
Name:SWIONTEK, MELISSA M (OTL)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:M
Last Name:SWIONTEK
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11125 SW 125TH PL
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-3508
Mailing Address - Country:US
Mailing Address - Phone:503-201-9711
Mailing Address - Fax:
Practice Address - Street 1:11125 SW 125TH PL
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-3508
Practice Address - Country:US
Practice Address - Phone:503-201-9711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1055602225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist