Provider Demographics
NPI:1689279531
Name:GREATHOUSE, MELANY
Entity Type:Individual
Prefix:
First Name:MELANY
Middle Name:
Last Name:GREATHOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5209 BLUE IVY
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-2380
Mailing Address - Country:US
Mailing Address - Phone:979-575-0855
Mailing Address - Fax:
Practice Address - Street 1:814 ARION PKWY STE 434
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2835
Practice Address - Country:US
Practice Address - Phone:954-608-6590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112219225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist