MEDICARE: MELANIE ROSE PALEN NG 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	225X00000X	Occupational Therapist	116565	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	116565	OTHER	TX	OCCUPATIONAL THERAPIST LICENSE

General Provider Information

NPI Number	:	1265818439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE ROSE PALEN NG OTR

Provider Business Mailing Address
First Line	:	21801 NORTHCREST DR
Second Line	:	APT 1822
City	:	SPRING
State	:	TX
Zip	:	77388-4063
Country	:	US
Telephone Number	:	551-208-7315
Fax Number	:

Provider Business Practice Location Address
First Line	:	21801 NORTHCREST DR
Second Line	:	APT 1822
City	:	SPRING
State	:	TX
Zip	:	77388-4063
Country	:	US
Telephone Number	:	551-208-7315
Fax Number	:

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

Provider Enumeration Date	:	08/10/2015
Last Update Date	:	08/10/2015

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