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NPI Code Detail

MEDICARE: MELANIE CAROLE GOODRICH LOT

MEDICARE: MELANIE CAROLE GOODRICH LOT
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 Therapist109965TX
2225XP0200XPediatric Occupational Therapist109965TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2832T36OTHERTXBLUE CROSS BLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417063496
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELANIE CAROLE GOODRICH LOT
Provider Business Mailing Address
First Line : PO BOX 2603
Second Line :
City : FT WORTH
State : TX
Zip : 76113-2603
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3840 HULEN ST STE 100
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-7269
Country : US
Telephone Number : 817-569-4413
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2006
Last Update Date : 01/30/2026

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Directions to “ MELANIE CAROLE GOODRICH LOT” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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