MEDICARE: MARITZA MARLENE MACHESNEY

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	:	1245479898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARITZA MARLENE MACHESNEY

Provider Business Mailing Address
First Line	:	8514 MISTY RIVER CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33637-4926
Country	:	US
Telephone Number	:	813-924-5051
Fax Number	:

Provider Business Practice Location Address
First Line	:	8514 MISTY RIVER CT
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33637-4926
Country	:	US
Telephone Number	:	813-924-5051
Fax Number	:

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

Provider Enumeration Date	:	02/05/2009
Last Update Date	:	02/05/2009

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Directions to “ MARITZA MARLENE MACHESNEY ” Practice Location

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