MEDICARE: MELANIE MICHELLE PIERCY

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	222Q00000X	Developmental Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093378721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE MICHELLE PIERCY

Provider Business Mailing Address
First Line	:	107 E TEAGUE BAY DR
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-3096
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1210 18TH AVE N
Second Line	:
City	:	JAX BCH
State	:	FL
Zip	:	32250-3756
Country	:	US
Telephone Number	:	727-741-3405
Fax Number	:	904-306-7826

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

Provider Enumeration Date	:	04/18/2019
Last Update Date	:	04/18/2019

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