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General NPI Number Information
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NPI Number | 1689550501
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Entity Type | Individual
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Provider Name | MELODIE PENN
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Gender | Female
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 2200 CHATEAU BLVD
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City | PARAGOULD
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State | AR
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Zip | 72450-6264
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Country | US
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Telephone | 501-725-0379
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Fax |
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Provider Business Mailing Address
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Address Line | 1725 MEADOWLARK
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City | POCAHONTAS
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State | AR
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Zip | 72455-1493
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Country | US
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Telephone | 870-378-2583
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Fax | 870-378-2583
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTR3682
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License Number State | AR
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