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General NPI Number Information
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NPI Number | 1508504002
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Entity Type | Individual
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Provider Name | MELINDA LU OSBURN
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Gender | Female
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Dates
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Enumeration Date | 05/24/2022
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 1600 BUNDY ST
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City | MATADOR
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State | TX
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Zip | 79244-2039
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Country | US
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Telephone | 806-347-2663
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 387
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City | PADUCAH
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State | TX
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Zip | 79248-0387
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Country | US
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Telephone | 806-269-0649
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 17067
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License Number State | TX
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