1407477862 NPI number — MELODY MELLO RBT

Table of content: MELODY MELLO RBT (NPI 1407477862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407477862 NPI number — MELODY MELLO RBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MELLO
Provider First Name:
MELODY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RBT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
MELODY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407477862
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
903 PARKVIEW CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEWITT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76643-3265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-312-1315
Provider Business Mailing Address Fax Number:
866-790-8027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
903 PARKVIEW CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEWITT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76643-3265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-312-1315
Provider Business Practice Location Address Fax Number:
866-790-8027
Provider Enumeration Date:
04/27/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RBT-18-74653 . This is a "BACB" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com