Individual
MELISSA MATIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
606 S 9TH ST, LEESBURG, FL 34748-6320
(860) 490-2717
Mailing address
606 S 9TH ST, LEESBURG, FL 34748-6320
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
11757
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
224Z00000X
—
FL
Enumeration date
04/08/2020
Last updated
04/08/2020
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