Healthcare Provider Details

I. General information

NPI: 1245075787
Provider Name (Legal Business Name): MARGARET ANNE MELLA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5144 ANGOLA ST
OCOEE FL
34761-3919
US

IV. Provider business mailing address

5144 ANGOLA ST
OCOEE FL
34761-3919
US

V. Phone/Fax

Practice location:
  • Phone: 407-399-3691
  • Fax:
Mailing address:
  • Phone: 407-399-3691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA43970
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH15106
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: