Provider Demographics
NPI:1871046490
Name:MILLSAP, MELODY (COTA)
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:
Last Name:MILLSAP
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:ANN
Other - Last Name:MILLSAP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:6351 FM 1616
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75752-6841
Mailing Address - Country:US
Mailing Address - Phone:903-477-2695
Mailing Address - Fax:
Practice Address - Street 1:100 E FERGUSON ST STE 1204
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-5700
Practice Address - Country:US
Practice Address - Phone:903-509-2040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210673224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant