Provider Demographics
NPI:1891274247
Name:LOVEN, MELISSA DEANNE (OTA)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DEANNE
Last Name:LOVEN
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 S POLARIS ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4509
Mailing Address - Country:US
Mailing Address - Phone:580-775-4269
Mailing Address - Fax:
Practice Address - Street 1:3515 S PARK AVE
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-7342
Practice Address - Country:US
Practice Address - Phone:903-327-8537
Practice Address - Fax:903-327-8794
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211109224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant