MEDICARE: MELISSA SHOLOMICKY

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	225200000X	Physical Therapy Assistant	0977	WY
2	225200000X	Physical Therapy Assistant	001096	CT
3	225200000X	Physical Therapy Assistant	09465	OR

General Provider Information

NPI Number	:	1942595889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA SHOLOMICKY

Provider Business Mailing Address
First Line	:	30 COVENTRY LN
Second Line	:
City	:	NAUGATUCK
State	:	CT
Zip	:	06770-1544
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 BIRCH ST
Second Line	:
City	:	JUNCTION CITY
State	:	OR
Zip	:	97448-1524
Country	:	US
Telephone Number	:	541-998-2395
Fax Number	:

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

Provider Enumeration Date	:	06/17/2011
Last Update Date	:	08/31/2021

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Directions to “ MELISSA SHOLOMICKY ” Practice Location

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