MEDICARE: MELISSA SEYMOUR OTR/L

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	225XP0200X	Pediatric Occupational Therapist	018856	NY

General Provider Information

NPI Number	:	1265842876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA SEYMOUR OTR/L

Provider Business Mailing Address
First Line	:	3500 EDSON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-5813
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 EDSON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-5813
Country	:	US
Telephone Number	:	718-325-1138
Fax Number	:

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

Provider Enumeration Date	:	05/05/2014
Last Update Date	:	11/03/2014

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