Provider Demographics
NPI:1053287813
Name:CAMPOS, MELISSA A (OTA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:A
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA
Mailing Address - Street 1:6502 SLIDE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-1311
Mailing Address - Country:US
Mailing Address - Phone:806-686-0429
Mailing Address - Fax:
Practice Address - Street 1:6502 SLIDE RD STE 204
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1311
Practice Address - Country:US
Practice Address - Phone:806-686-0429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208336224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant