Provider Demographics
NPI:1225149768
Name:LUNN, MELINDA E (OTRL)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:E
Last Name:LUNN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3398 E CANTERBURY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-2862
Mailing Address - Country:US
Mailing Address - Phone:479-251-0192
Mailing Address - Fax:479-582-2746
Practice Address - Street 1:237 E MILSAP RD
Practice Address - Street 2:SUITE 7
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-6288
Practice Address - Country:US
Practice Address - Phone:479-582-2740
Practice Address - Fax:479-582-2746
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR660225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5T778OtherBCBS