Healthcare Provider Details

I. General information

NPI: 1225149768
Provider Name (Legal Business Name): MELINDA E LUNN OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 E MILSAP RD SUITE 7
FAYETTEVILLE AR
72703-6288
US

IV. Provider business mailing address

3398 E CANTERBURY CIRCLE
FAYETTEVILLE AR
72701-2862
US

V. Phone/Fax

Practice location:
  • Phone: 479-582-2740
  • Fax: 479-582-2746
Mailing address:
  • Phone: 479-251-0192
  • Fax: 479-582-2746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOTR660
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: