MEDICARE: MELISSA BLAKE JAMES 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
1	225XH1200X	Hand Occupational Therapist	110055	TX

General Provider Information

NPI Number	:	1205836665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA BLAKE JAMES OTR

Provider Business Mailing Address
First Line	:	803 W TERRELL AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3155
Country	:	US
Telephone Number	:	817-877-3113
Fax Number	:	817-877-0022

Provider Business Practice Location Address
First Line	:	803 W TERRELL AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3155
Country	:	US
Telephone Number	:	817-877-3113
Fax Number	:	817-877-0022

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	03/31/2009

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