MEDICARE: MELISSA ELROD MOTRL

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	5650	NC

General Provider Information

NPI Number	:	1295868404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA ELROD MOTRL

Provider Business Mailing Address
First Line	:	3905 WALDON CT
Second Line	:
City	:	HIGH POINT
State	:	NC
Zip	:	27265-9586
Country	:	US
Telephone Number	:	336-317-0940
Fax Number	:

Provider Business Practice Location Address
First Line	:	5755 SHATTALON DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27105-1332
Country	:	US
Telephone Number	:	336-744-2779
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	04/29/2009

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