Healthcare Provider Details

I. General information

NPI: 1396111290
Provider Name (Legal Business Name): MELINDA TRAUTWEIN OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 GARWOOD ST
SMITHVILLE TX
78957-1117
US

IV. Provider business mailing address

907 GARWOOD ST
SMITHVILLE TX
78957-1117
US

V. Phone/Fax

Practice location:
  • Phone: 512-237-4606
  • Fax: 512-237-5492
Mailing address:
  • Phone: 512-237-4606
  • Fax: 512-237-5492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number104955
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: