Active NPI
Melissa Mundo, MS, OTR/L
- Occupational Therapist
- Fort Worth, TX
National Provider Identifier
1609172709
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 118521
- Practice address
- 1101 W Vickery Blvd
Fort Worth, TX 76104-1025 - Phone
- (682) 885-6294
- Fax
- (682) 885-1135
- NPI assigned
- Feb 7, 2011
- Last updated
- Aug 20, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 118521 | TX | Primary |
Addresses
Primary practice location
1101 W Vickery Blvd
Fort Worth, TX 76104-1025
Mailing address
PO Box 99283
Fort Worth, TX 76199-0283
Phone (682) 885-6294
Other practice location 1
250 Sante Fe Drive
Weatherford, TX 76086
Phone (817) 550-5058
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0119006481 | Other | VA | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 118521 | TX | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PCT Speech Therapy PLLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Speech-Language Pathologist
- Southlake, TX
- NPI 1427436872
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1297036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534723200000",
"number": "1609172709",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 99283",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761990283",
"telephone_number": "682-885-6294",
"fax_number": "682-885-1135"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 W VICKERY BLVD",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761041025",
"telephone_number": "682-885-6294",
"fax_number": "682-885-1135"
}
],
"practiceLocations": [
{
"address_1": "250 Sante Fe Drive",
"address_purpose": "LOCATION",
"city": "Weatherford",
"state": "TX",
"postal_code": "76086",
"country_code": "US",
"telephone_number": "817-550-5058",
"fax_number": "817-509-8177",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MUNDO",
"first_name": "MELISSA",
"credential": "MS, OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-02-07",
"last_updated": "2018-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "TX",
"license": "118521",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "0119006481",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.