Provider Demographics
NPI:1306016910
Name:SEVESTRE, MELISSA JANE (MOT OTRL)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:SEVESTRE
Suffix:
Gender:F
Credentials:MOT OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11011 SHERIDAN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-1532
Mailing Address - Country:US
Mailing Address - Phone:954-499-1125
Mailing Address - Fax:954-499-1123
Practice Address - Street 1:11011 SHERIDAN ST STE 302
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33026-1532
Practice Address - Country:US
Practice Address - Phone:954-499-1125
Practice Address - Fax:954-499-1123
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOTT13089OtherSTATE LICENSE