Individual
MICHAEL MIFSUD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
1535 COGSWELL ST STE C24, ROCKLEDGE, FL 32955-2740
(321) 872-8737
Mailing address
520 WICKHAM LAKES DR, MELBOURNE, FL 32940-2216
(321) 243-4605
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
17299
FL
Other
Enumeration date
12/09/2019
Last updated
12/09/2019
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