Provider Demographics
NPI:1053433821
Name:LAMB, MELISSA WEAVER (OTR-L)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:WEAVER
Last Name:LAMB
Suffix:
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:PO BOX 814
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:AR
Mailing Address - Zip Code:72556-0814
Mailing Address - Country:US
Mailing Address - Phone:870-368-7225
Mailing Address - Fax:
Practice Address - Street 1:701 MAIN ST.
Practice Address - Street 2:SUITE B
Practice Address - City:MELBOURNE
Practice Address - State:AR
Practice Address - Zip Code:72556
Practice Address - Country:US
Practice Address - Phone:870-368-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR1310225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR138707721Medicaid
AR5V131G198OtherMEDICARE