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Individual
MRS. MELISSA M FORTENBERRY
Active
Individual
MRS. MELISSA M FORTENBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Taxonomy
Speciality
Code
Description
License number
State
225XN1300X
Neurorehabilitation Occupational Therapist
Primary
107939
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1016955
BLUE LINK NUMBER
TX
01
—
107939
LISCENSE
TX
01
—
P00357763
RAILROAD MEDICARE PROVIDE
TX
Enumeration date
05/19/2006
Last updated
12/28/2007
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