MEDICARE: MELISSA JANE SEVESTRE MOT OTRL

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OTT13089	OTHER	FL	STATE LICENSE

General Provider Information

NPI Number	:	1306016910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA JANE SEVESTRE MOT OTRL

Provider Business Mailing Address
First Line	:	11011 SHERIDAN ST STE 302
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-1532
Country	:	US
Telephone Number	:	954-499-1125
Fax Number	:	954-499-1123

Provider Business Practice Location Address
First Line	:	11011 SHERIDAN ST STE 302
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33026-1532
Country	:	US
Telephone Number	:	954-499-1125
Fax Number	:	954-499-1123

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

Provider Enumeration Date	:	03/11/2008
Last Update Date	:	03/11/2008

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