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
State | License ID | Taxonomies |
---|---|---|
TX | 101195 | 225XH1200X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225XH1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | BCBS | Other | 896T18 |
TX | BCBS | Other | 896T19 |
TX | 334804YYMR | Medicare UPIN | |
TX | 334804YRG6 | Medicare PIN | |
TX | 334804YZ87 | Medicare PIN |