Healthcare Provider Details

I. General information

NPI: 1891274247
Provider Name (Legal Business Name): MELISSA DEANNE LOVEN OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 S PARK AVE
DENISON TX
75020-7342
US

IV. Provider business mailing address

1909 S POLARIS ST
DENISON TX
75020-4509
US

V. Phone/Fax

Practice location:
  • Phone: 903-327-8537
  • Fax: 903-327-8794
Mailing address:
  • Phone: 580-775-4269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number211109
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: