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NPI Code Detail

MEDICARE: MRS. MELANIE D EARLES OTR

MEDICARE: MRS. MELANIE D EARLES OTR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistOT001722GA

General Provider Information

NPI Number : 1194829358
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MELANIE D EARLES OTR
Provider Business Mailing Address
First Line : 3891 HILLCREST DRIVE
Second Line :
City : SMYRNA
State : GA
Zip : 30080
Country : US
Telephone Number : 770-435-8322
Fax Number :
Provider Business Practice Location Address
First Line : 2155 W PARK CT
Second Line : SUITE G/H
City : STONE MOUNTAIN
State : GA
Zip : 30087-3500
Country : US
Telephone Number : 770-465-5084
Fax Number : 770-465-5304
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2006
Last Update Date : 07/08/2007

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