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General NPI Number Information
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NPI Number | 1306207022
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Entity Type | Individual
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Provider Name | MELODY BOHN
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Gender | Female
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Dates
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Enumeration Date | 03/08/2016
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 8011 AMY HEWES DR
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City | SHREVEPORT
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State | LA
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Zip | 71115-4605
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Country | US
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Telephone | 478-808-6145
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Fax |
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Provider Business Mailing Address
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Address Line | 8011 AMY HEWES DR
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City | SHREVEPORT
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State | LA
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Zip | 71115-4605
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Country | US
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Telephone | 478-808-6145
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-18-59681
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | T-04459
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | L-487
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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