MEDICARE: ROBYN MELLANG

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	073264	IA

General Provider Information

NPI Number	:	1891184255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBYN MELLANG

Provider Business Mailing Address
First Line	:	5114 BUSHNELL AVE
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-3737
Country	:	US
Telephone Number	:	605-691-5093
Fax Number	:

Provider Business Practice Location Address
First Line	:	5114 BUSHNELL AVE
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51106-3737
Country	:	US
Telephone Number	:	605-691-5093
Fax Number	:

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

Provider Enumeration Date	:	01/22/2015
Last Update Date	:	06/11/2020

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Directions to “ ROBYN MELLANG ” Practice Location

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