Provider Demographics
NPI:1194028480
Name:BERNAL, MELINDA DAWN (OTR/L)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:DAWN
Last Name:BERNAL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 ANAYA RD
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-7569
Mailing Address - Country:US
Mailing Address - Phone:505-864-7812
Mailing Address - Fax:505-864-7812
Practice Address - Street 1:38 ANAYA RD
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-7569
Practice Address - Country:US
Practice Address - Phone:505-864-7812
Practice Address - Fax:505-864-7812
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM846225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist