Provider Demographics
NPI:1730479460
Name:BACAK, MELINDA SPILLERS
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:SPILLERS
Last Name:BACAK
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 1:18484 PRESTON RD
Mailing Address - Street 2:STE 102, PMB 156
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5400
Mailing Address - Country:US
Mailing Address - Phone:972-342-7419
Mailing Address - Fax:
Practice Address - Street 1:2100 SAM HOUSTON AVENUE
Practice Address - Street 2:STE D
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5182
Practice Address - Country:US
Practice Address - Phone:936-293-8800
Practice Address - Fax:936-293-8841
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109504225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist