Healthcare Provider Details

I. General information

NPI: 1215709100
Provider Name (Legal Business Name): MELISSA D PUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95121 VILLAGGIO DELGI ULIVI
SIGONELLA AE
09627
IT

IV. Provider business mailing address

PSC 812 BOX 344
FPO AE
09627
IT

V. Phone/Fax

Practice location:
  • Phone: 314-624-4568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18919
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: