Provider Demographics
NPI:1902388101
Name:DUCKWORTH, MELANIE DENISE (COTA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:DENISE
Last Name:DUCKWORTH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6705 ROARING CRK
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-1799
Mailing Address - Country:US
Mailing Address - Phone:972-561-0249
Mailing Address - Fax:
Practice Address - Street 1:120 MEADOW VIEW DR
Practice Address - Street 2:
Practice Address - City:JUSTIN
Practice Address - State:TX
Practice Address - Zip Code:76247-9639
Practice Address - Country:US
Practice Address - Phone:940-648-2731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206423224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty