MEDICARE: MELANIE CONWAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417583048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE CONWAY

Provider Business Mailing Address
First Line	:	11820 DENTON AVE
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34667-5419
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1816 W FLORA ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5332
Country	:	US
Telephone Number	:	941-744-6921
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2020
Last Update Date	:	03/16/2020

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Directions to “ MELANIE CONWAY ” Practice Location

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