Provider Demographics
NPI:1164719696
Name:LAY, MELODY CHERIE
Entity Type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:CHERIE
Last Name:LAY
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 1:2926 S MORNINGSIDE CT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6925
Mailing Address - Country:US
Mailing Address - Phone:407-421-5002
Mailing Address - Fax:
Practice Address - Street 1:1015 LAKE GRACIE DR
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-4666
Practice Address - Country:US
Practice Address - Phone:352-409-6720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist