MEDICARE: MELISSA HOLMSTROM

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	22360	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P010011417	OTHER	NY	EXCELLUS
2	7514738	OTHER	NY	AETNA
3	MDJ001	OTHER	NY	PREFERRED CARE
4	P02011417	OTHER	NY	CROSSBRIDGE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780737999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA HOLMSTROM

Provider Business Mailing Address
First Line	:	7130 EMERALD SPRING LOOP
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-6961
Country	:	US
Telephone Number	:	585-509-1140
Fax Number	:

Provider Business Practice Location Address
First Line	:	36430 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-1330
Country	:	US
Telephone Number	:	727-330-0240
Fax Number	:

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	02/20/2023

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Directions to “ MELISSA HOLMSTROM ” Practice Location

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