Healthcare Provider Details

I. General information

NPI: 1073608881
Provider Name (Legal Business Name): MELANIE B AUSTIN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 WEST RAILROAD AVE. NORTH
CRYSTAL SPRINGS MS
39059
US

IV. Provider business mailing address

2159 CROSSBRIDGE BLVD
BYRAM MS
39272-8724
US

V. Phone/Fax

Practice location:
  • Phone: 601-892-8707
  • Fax:
Mailing address:
  • Phone: 601-668-5390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT0010
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: