Provider Demographics
NPI:1083876601
Name:MATAMOROS, MELISSA MARIE (OTR)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:MARIE
Last Name:MATAMOROS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12710 RESEARCH BLVD
Mailing Address - Street 2:SUITE 395
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4379
Mailing Address - Country:US
Mailing Address - Phone:512-331-4115
Mailing Address - Fax:512-331-8176
Practice Address - Street 1:12710 RESEARCH BLVD
Practice Address - Street 2:SUITE 395
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4379
Practice Address - Country:US
Practice Address - Phone:512-331-4115
Practice Address - Fax:512-331-8176
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110860225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics