MEDICARE: MRS. MICHELLE MELITO JOHNSON OTR, CHT

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	225XH1200X	Hand Occupational Therapist	111037	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8T2888	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1083743462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE MELITO JOHNSON OTR, CHT

Provider Business Mailing Address
First Line	:	22 S PENTENWELL CIR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77382-1788
Country	:	US
Telephone Number	:	281-298-6404
Fax Number	:

Provider Business Practice Location Address
First Line	:	19073 INTERSTATE 45 S STE 145
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77385-8744
Country	:	US
Telephone Number	:	936-321-4700
Fax Number	:	936-321-4848

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

Provider Enumeration Date	:	03/03/2007
Last Update Date	:	07/08/2007

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