Provider Demographics
NPI:1992265722
Name:LUTTRELL, MELODY DAWN III (OTR/L)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:DAWN
Last Name:LUTTRELL
Suffix:III
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 BIBBS RD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-9358
Mailing Address - Country:US
Mailing Address - Phone:870-926-3142
Mailing Address - Fax:
Practice Address - Street 1:385 HARMONY RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-7102
Practice Address - Country:US
Practice Address - Phone:870-926-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2229225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics