MEDICARE: MELISSA SMITH

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

General Provider Information

NPI Number	:	1497563266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA SMITH

Provider Business Mailing Address
First Line	:	2547 ANGEL CT
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32563-5552
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 CROSSVILLE ST
Second Line	:
City	:	CANTONMENT
State	:	FL
Zip	:	32533-6587
Country	:	US
Telephone Number	:	850-203-1745
Fax Number	:

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

Provider Enumeration Date	:	12/24/2024
Last Update Date	:	12/24/2024

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Directions to “ MELISSA SMITH ” Practice Location

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