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General NPI Number Information
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NPI Number | 1689558546
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Entity Type | Individual
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Provider Name | ELIZABETH MARIE MELLOW OTR/L
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Gender | Female
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 1132 E 12TH ST
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City | DOUGLAS
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State | AZ
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Zip | 85607-2337
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Country | US
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Telephone | 520-364-2447
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Fax | 520-762-4384
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Provider Business Mailing Address
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Address Line | PO BOX 477
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City | PEARCE
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State | AZ
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Zip | 85625-0477
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Country | US
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Telephone | 520-895-1968
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OTH-009238
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License Number State | AZ
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