MEDICARE: MELANIE J GAUTHIER

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	OT10255	FL

General Provider Information

NPI Number	:	1972087831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE J GAUTHIER

Provider Business Mailing Address
First Line	:	4424 RICHMOND PARK CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-2230
Country	:	US
Telephone Number	:	904-821-1512
Fax Number	:

Provider Business Practice Location Address
First Line	:	4424 RICHMOND PARK CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-2230
Country	:	US
Telephone Number	:	904-821-1512
Fax Number	:

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

Provider Enumeration Date	:	09/17/2018
Last Update Date	:	09/17/2018

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Directions to “ MELANIE J GAUTHIER ” Practice Location

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