Healthcare Provider Details

I. General information

NPI: 1225803315
Provider Name (Legal Business Name): MELANIE MARTINA MEJIA-PICARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6840 COOLIDGE HWY
GUILFORD VT
05301-8641
US

IV. Provider business mailing address

6840 COOLIDGE HWY
GUILFORD VT
05301-8641
US

V. Phone/Fax

Practice location:
  • Phone: 646-942-0134
  • Fax:
Mailing address:
  • Phone: 646-942-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number041.0092478
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: