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NPI Code Detail

MEDICARE: MELISSA MALLORY OTR/L

MEDICARE: MELISSA MALLORY OTR/L
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
1225X00000XOccupational TherapistOT20328FL

General Provider Information

NPI Number : 1548805575
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA MALLORY OTR/L
Provider Business Mailing Address
First Line : 19630 LAKE OSCEOLA LN
Second Line :
City : ODESSA
State : FL
Zip : 33556-1709
Country : US
Telephone Number : 813-992-6857
Fax Number :
Provider Business Practice Location Address
First Line : 13719 DALLAS DR
Second Line :
City : HUDSON
State : FL
Zip : 34667-7133
Country : US
Telephone Number : 727-862-6795
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2019
Last Update Date : 11/13/2019

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Directions to “ MELISSA MALLORY OTR/L” Practice Location

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