Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 110674 | TX |
NPI | 1124245857 |
---|---|
Provider Name | Melinda Matte Battenfield |
First Address | Dallas, TX 75246-1621 |
Second Address | Dallas, TX 75246-1621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 07/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
760471599 | TAX ID (01) | TX |
8T0818 | BLUECROSSBLUESHIELD (01) | TX |