MEDICARE: LAURA MELGUN OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	OT-004986	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336569086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MELGUN OTR/L

Provider Business Mailing Address
First Line	:	1440 LAKESIDE AVE E
Second Line	:	RM 210
City	:	CLEVELAND
State	:	OH
Zip	:	44114-1137
Country	:	US
Telephone Number	:	216-592-7236
Fax Number	:

Provider Business Practice Location Address
First Line	:	3690 W 159TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-5706
Country	:	US
Telephone Number	:	216-252-2131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2014
Last Update Date	:	04/21/2014

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Directions to “ LAURA MELGUN OTR/L” Practice Location

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