Provider Demographics
NPI:1538304480
Name:UNDERWOOD, MELINDA ARMSTRONG (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:ARMSTRONG
Last Name:UNDERWOOD
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 1:318 PAISANO DR
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:TX
Mailing Address - Zip Code:79510-3548
Mailing Address - Country:US
Mailing Address - Phone:325-893-5203
Mailing Address - Fax:
Practice Address - Street 1:806 STEPHENS ST
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:TX
Practice Address - Zip Code:79510-4554
Practice Address - Country:US
Practice Address - Phone:325-893-4288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-06
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111349225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist