MEDICARE: MELISSA KENT NEAL OT

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	210698	LA

General Provider Information

NPI Number	:	1487623450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA KENT NEAL OT

Provider Business Mailing Address
First Line	:	PO BOX 398
Second Line	:
City	:	AMITE
State	:	LA
Zip	:	70422-0398
Country	:	US
Telephone Number	:	985-748-7878
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 NORTH SECOND ST
Second Line	:
City	:	AMITE
State	:	LA
Zip	:	70422-0398
Country	:	US
Telephone Number	:	985-748-7878
Fax Number	:	985-748-2837

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	12/27/2007

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