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General NPI Number Information
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NPI Number | 1003273624
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Entity Type | Individual
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Provider Name | MELINDA UNDERWOOD OTLP
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Gender | Female
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Dates
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Enumeration Date | 01/27/2016
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Last Update Date | 03/07/2018
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Provider Practice Location Address
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Address Line | 9618 GARDEN GROVE BLVD
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City | GARDEN GROVE
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State | CA
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Zip | 92844-1563
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Country | US
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Telephone | 714-530-3115
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Fax |
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Provider Business Mailing Address
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Address Line | 2140 LOGGIA
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-9041
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Country | US
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Telephone | 949-280-1888
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XG0600X
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Taxonomy Name | Gerontology Occupational Therapist
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License Number | 10095
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License Number State | CA
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