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General NPI Number Information
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NPI Number | 1942595889
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Entity Type | Individual
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Provider Name | MELISSA SHOLOMICKY
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Gender | Female
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Dates
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Enumeration Date | 06/17/2011
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 530 BIRCH ST
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City | JUNCTION CITY
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State | OR
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Zip | 97448-1524
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Country | US
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Telephone | 541-998-2395
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Fax |
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Provider Business Mailing Address
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Address Line | 30 COVENTRY LN
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City | NAUGATUCK
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State | CT
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Zip | 06770-1544
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 0977
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 001096
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 09465
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License Number State | OR
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