MEDICARE: MELISSA MCCUTCHEON LMT

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	208D00000X	General Practice Physician	33.018506	OH

General Provider Information

NPI Number	:	1912239484
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA MCCUTCHEON LMT

Provider Business Mailing Address
First Line	:	7203 GERALD AVE
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44129-3243
Country	:	US
Telephone Number	:	440-341-8902
Fax Number	:

Provider Business Practice Location Address
First Line	:	23131 EMERY RD
Second Line	:
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44128-5136
Country	:	US
Telephone Number	:	216-514-9590
Fax Number	:

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

Provider Enumeration Date	:	02/08/2010
Last Update Date	:	02/08/2010

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