Individual
MICHELLE RIDDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
760 NORTH DR, MELBOURNE, FL 32934-9216
(321) 253-3000
Mailing address
760 NORTH DR, MELBOURNE, FL 32934-9216
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
581584862
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1952333122
—
FL
Enumeration date
03/15/2017
Last updated
03/15/2017
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