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General NPI Number Information
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NPI Number | 1306480314
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Entity Type | Individual
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Provider Name | MELODY AVERETT
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Gender | Female
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Dates
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Enumeration Date | 11/01/2019
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Last Update Date | 11/01/2019
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Provider Practice Location Address
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Address Line | 1527 WORTH STREET
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City | HEMPHILL
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State | TX
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Zip | 75948
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Country | US
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Telephone | 936-201-2606
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Fax |
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Provider Business Mailing Address
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Address Line | 4537 STATE LINE RD
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City | LOGANSPORT
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State | LA
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Zip | 71049-3156
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Country | US
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Telephone | 318-540-8076
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 213056
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License Number State | TX
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