Healthcare Provider Details

I. General information

NPI: 1467923201
Provider Name (Legal Business Name): MELISSA WAWRZYNIAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 17TH ST
SARASOTA FL
34235-1843
US

IV. Provider business mailing address

4905 BOSTON COMMON GLN
BRADENTON FL
34211-8494
US

V. Phone/Fax

Practice location:
  • Phone: 941-487-5400
  • Fax:
Mailing address:
  • Phone: 248-469-3944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6040
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT21043
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: