Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1972 | OK |
NPI | 1063885317 |
---|---|
Provider Name | Zachary Melton |
First Address | Shawnee, OK 74804-9635 |
Second Address | Oklahoma City, OK 73118-4006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2015 |
Last Update Date | 09/11/2015 |