=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437478369
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE S. MYLES PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2010
-----------------------------------------------------
Last Update Date | 05/17/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1072 GRAND AVE APT. A
-----------------------------------------------------
City | OLIVEHURST
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95961-7080
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-975-5539
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 865 MITCHELL AVE
-----------------------------------------------------
City | OROVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95965-4646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-538-7950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 167G00000X
-----------------------------------------------------
Taxonomy Name | Licensed Psychiatric Technician
-----------------------------------------------------
License Number | 34456
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------