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General NPI Number Information
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NPI Number | 1558732131
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Entity Type | Individual
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Provider Name | MELISSA BERUTTO
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Gender | Female
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 04/14/2017
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Provider Practice Location Address
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Address Line | 5236 W PEORIA AVE APT 238
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City | GLENDALE
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State | AZ
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Zip | 85302-1624
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Country | US
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Telephone | 602-575-4385
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Fax |
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Provider Business Mailing Address
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Address Line | 8724 W WINDSOR DR
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City | PEORIA
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State | AZ
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Zip | 85381-5114
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Country | US
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Telephone | 602-575-4385
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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 | 6110
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License Number State | AZ
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