Provider Demographics
NPI:1093378721
Name:PIERCY, MELANIE MICHELLE
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:MICHELLE
Last Name:PIERCY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E TEAGUE BAY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3096
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1210 18TH AVE N
Practice Address - Street 2:
Practice Address - City:JAX BCH
Practice Address - State:FL
Practice Address - Zip Code:32250-3756
Practice Address - Country:US
Practice Address - Phone:727-741-3405
Practice Address - Fax:904-306-7826
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist