Provider Demographics
NPI:1003273624
Name:UNDERWOOD, MELINDA (OTLP)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:OTLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 LOGGIA
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-9041
Mailing Address - Country:US
Mailing Address - Phone:949-280-1888
Mailing Address - Fax:
Practice Address - Street 1:9618 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1563
Practice Address - Country:US
Practice Address - Phone:714-530-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10095225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology