Provider Demographics
NPI:1124390711
Name:MCDOUGALD, MELISSA GAIL
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:GAIL
Last Name:MCDOUGALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 PARKWOOD BLVD APT 415
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4788
Mailing Address - Country:US
Mailing Address - Phone:361-249-6096
Mailing Address - Fax:
Practice Address - Street 1:3200 PARKWOOD BLVD APT 415
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4788
Practice Address - Country:US
Practice Address - Phone:361-249-6096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211245224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant