Provider Demographics
NPI:1396111290
Name:TRAUTWEIN, MELINDA (OTR)
Entity type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:
Last Name:TRAUTWEIN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 GARWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78957-1117
Mailing Address - Country:US
Mailing Address - Phone:512-237-4606
Mailing Address - Fax:512-237-5492
Practice Address - Street 1:907 GARWOOD ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TX
Practice Address - Zip Code:78957-1117
Practice Address - Country:US
Practice Address - Phone:512-237-4606
Practice Address - Fax:512-237-5492
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104955225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist