Provider Demographics
NPI:1912520404
Name:MINDFUL LIVING LLC
Entity Type:Organization
Organization Name:MINDFUL LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELLANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-691-5093
Mailing Address - Street 1:5114 BUSHNELL AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-3737
Mailing Address - Country:US
Mailing Address - Phone:605-691-5093
Mailing Address - Fax:
Practice Address - Street 1:5114 BUSHNELL AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-3737
Practice Address - Country:US
Practice Address - Phone:605-691-5093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-19
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty