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General NPI Number Information
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NPI Number | 1316513617
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Entity Type | Individual
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Provider Name | MELISSA JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 05/28/2021
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 1101 PARC HILL BLVD
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City | ORANGE CITY
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State | FL
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Zip | 32763-8029
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Country | US
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Telephone | 386-960-8277
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Fax | 857-290-9134
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Provider Business Mailing Address
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Address Line | 4580 ALDER DR
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City | PORT ORANGE
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State | FL
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Zip | 32127-9255
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Country | US
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Telephone | 386-451-7957
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA10749
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License Number State | FL
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