Healthcare Provider Details

I. General information

NPI: 1417053307
Provider Name (Legal Business Name): MELISSA BEATRICE FLOYSAND OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 ENLOE ST
HUDSON WI
54016-8173
US

IV. Provider business mailing address

11325 INMAN AVE S
COTTAGE GROVE MN
55016-4517
US

V. Phone/Fax

Practice location:
  • Phone: 715-386-2128
  • Fax: 715-386-6119
Mailing address:
  • Phone: 651-768-8837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number3009
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: