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General NPI Number Information
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NPI Number | 1639311392
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Entity Type | Organization
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Legal Business Name | MELBOURNE THERAPY CLINIC INC
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 04/22/2009
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Provider Practice Location Address
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Address Line | 701 MAIN STREET SUITE B
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City | MELBOURNE
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State | AR
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Zip | 72556
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Country | US
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Telephone | 870-368-4774
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Fax | 870-368-4773
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Provider Business Mailing Address
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Address Line | PO BOX 814
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City | MELBOURNE
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State | AR
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Zip | 72556-0814
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Country | US
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Telephone | 870-368-4774
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Fax | 870-368-4773
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST/PRESIDENT
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Name | MRS. MELISSA W LAMB
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Credential | OTR/L
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Telephone | 870-368-4774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTR1310
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License Number State | AR
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