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NPI Code Detail

MEDICARE: MELISSA PERU

MEDICARE: MELISSA PERU
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
1224Z00000XOccupational Therapy Assistant5125AZ

General Provider Information

NPI Number : 1083052385
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA PERU
Provider Business Mailing Address
First Line : 479 RED ROCK RD
Second Line :
City : SILVER CITY
State : NM
Zip : 88061-9274
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2781 OSBORN DR
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86406-8629
Country : US
Telephone Number : 928-505-5552
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2013
Last Update Date : 06/07/2013

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Directions to “ MELISSA PERU ” Practice Location

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