MEDICARE: MELISSA SITARAM

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	22377	FL

General Provider Information

NPI Number	:	1487163622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA SITARAM

Provider Business Mailing Address
First Line	:	1824 TOUBY PIKE STE B
Second Line	:
City	:	KOKOMO
State	:	IN
Zip	:	46901-2573
Country	:	US
Telephone Number	:	765-628-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2711 EXCHANGE CT STE B
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-4017
Country	:	US
Telephone Number	:	561-494-4499
Fax Number	:

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

Provider Enumeration Date	:	09/20/2017
Last Update Date	:	11/01/2021

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