Healthcare Provider Details

I. General information

NPI: 1104750413
Provider Name (Legal Business Name): MELANIE YOMAR MENA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8785 SW 165TH AVE STE 202
MIAMI FL
33193-5828
US

IV. Provider business mailing address

6323 SW 162ND PATH
MIAMI FL
33193-4463
US

V. Phone/Fax

Practice location:
  • Phone: 305-900-3787
  • Fax:
Mailing address:
  • Phone: 786-301-9617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT27140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: