Provider Demographics
NPI:1265818439
Name:NG, MELANIE ROSE PALEN (OTR)
Entity Type:Individual
Prefix:
First Name:MELANIE ROSE
Middle Name:PALEN
Last Name:NG
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 1:21801 NORTHCREST DR
Mailing Address - Street 2:APT 1822
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4063
Mailing Address - Country:US
Mailing Address - Phone:551-208-7315
Mailing Address - Fax:
Practice Address - Street 1:21801 NORTHCREST DR
Practice Address - Street 2:APT 1822
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4063
Practice Address - Country:US
Practice Address - Phone:551-208-7315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116565225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116565OtherOCCUPATIONAL THERAPIST LICENSE