Healthcare Provider Details

I. General information

NPI: 1245542950
Provider Name (Legal Business Name): MELODY BURGESS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 07/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 MOORE ROAD
OCOEE FL
34761
US

IV. Provider business mailing address

13905 W. COLONIAL DRIVE #195
WINTER GARDEN FL
34787
US

V. Phone/Fax

Practice location:
  • Phone: 407-877-7117
  • Fax: 407-877-9981
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA 42382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: