MEDICARE: MARIE MELINDA LEVY OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	0T4308	FL

General Provider Information

NPI Number	:	1043559636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE MELINDA LEVY OTR

Provider Business Mailing Address
First Line	:	355 NE 115TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33161-6617
Country	:	US
Telephone Number	:	305-333-5441
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 NE 115TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33161-6617
Country	:	US
Telephone Number	:	305-333-5441
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2013
Last Update Date	:	02/03/2013

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