MEDICARE: MELISSA LYN WYSKIEL 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	225X00000X	Occupational Therapist	004157	CT

General Provider Information

NPI Number	:	1689089260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LYN WYSKIEL OTR/L

Provider Business Mailing Address
First Line	:	32 EDGEWOOD CT
Second Line	:
City	:	MIDDLEFIELD
State	:	CT
Zip	:	06455-1219
Country	:	US
Telephone Number	:	860-759-0076
Fax Number	:

Provider Business Practice Location Address
First Line	:	534 TOWN ST
Second Line	:
City	:	EAST HADDAM
State	:	CT
Zip	:	06423-1390
Country	:	US
Telephone Number	:	860-873-6547
Fax Number	:

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

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	06/23/2014

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