MEDICARE: MITCHELL UNDERWOOD

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	224Z00000X	Occupational Therapy Assistant	211736	TX

General Provider Information

NPI Number	:	1528439502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL UNDERWOOD

Provider Business Mailing Address
First Line	:	905 E LOS EBANOS BLVD STE C
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78520-8720
Country	:	US
Telephone Number	:	956-455-1869
Fax Number	:	956-544-2569

Provider Business Practice Location Address
First Line	:	905 E LOS EBANOS BLVD STE C
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78520-8720
Country	:	US
Telephone Number	:	956-455-1869
Fax Number	:	956-544-2569

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

Provider Enumeration Date	:	10/15/2015
Last Update Date	:	10/16/2015

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Directions to “ MITCHELL UNDERWOOD ” Practice Location

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