Provider Demographics
NPI:1710195086
Name:PEAVEY, MELISSA ANN (OTR,CHT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:PEAVEY
Suffix:
Gender:F
Credentials:OTR,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 674200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4200
Mailing Address - Country:US
Mailing Address - Phone:214-346-0677
Mailing Address - Fax:214-346-0324
Practice Address - Street 1:8144 WALNUT HILL LN
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4388
Practice Address - Country:US
Practice Address - Phone:214-346-0677
Practice Address - Fax:214-346-0324
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101195225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBCBSOther896T18
TXBCBSOther896T19
TX334804YYMRMedicare UPIN
TX334804YRG6Medicare PIN
TX334804YZ87Medicare PIN