Provider Demographics
NPI:1346462033
Name:WESTBROOK, MELODI ANNE (COTA)
Entity Type:Individual
Prefix:
First Name:MELODI
Middle Name:ANNE
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 TOWER DR STE 7
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4243
Mailing Address - Country:US
Mailing Address - Phone:432-335-8777
Mailing Address - Fax:
Practice Address - Street 1:808 TOWER DR STE 7
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4243
Practice Address - Country:US
Practice Address - Phone:432-335-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208816224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant