Healthcare Provider Details

I. General information

NPI: 1801936166
Provider Name (Legal Business Name): MELISSA SHIRAMIZU OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 WILLIAMS DR
GEORGETOWN TX
78628-2420
US

IV. Provider business mailing address

3610 WILLIAMS DR
GEORGETOWN TX
78628-2420
US

V. Phone/Fax

Practice location:
  • Phone: 512-256-7627
  • Fax: 512-375-3291
Mailing address:
  • Phone: 512-256-7627
  • Fax: 512-375-3291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number109822
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: