Provider Demographics
NPI:1336569086
Name:MELGUN, LAURA (OTR/L)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MELGUN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 LAKESIDE AVE E
Mailing Address - Street 2:RM 210
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-1137
Mailing Address - Country:US
Mailing Address - Phone:216-592-7236
Mailing Address - Fax:
Practice Address - Street 1:3690 W 159TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5706
Practice Address - Country:US
Practice Address - Phone:216-252-2131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT-004986225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0Medicaid