MEDICARE: MICHELLE MARQUEZ

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1982567301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE MARQUEZ

Provider Business Mailing Address
First Line	:	12760 WESTWOOD LAKES BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-2345
Country	:	US
Telephone Number	:	813-814-5971
Fax Number	:	813-814-5972

Provider Business Practice Location Address
First Line	:	13200 MCCORMICK DR STE E-1
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-3010
Country	:	US
Telephone Number	:	813-814-5971
Fax Number	:	813-814-5972

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

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	12/03/2025

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Directions to “ MICHELLE MARQUEZ ” Practice Location

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