Provider Demographics
NPI:1457499691
Name:ROSBOTTOM, MELISSA SUE (MS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:ROSBOTTOM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:662 93RD AVE N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-2439
Mailing Address - Country:US
Mailing Address - Phone:239-451-0087
Mailing Address - Fax:239-225-7774
Practice Address - Street 1:17595 S TAMIAMI TRL
Practice Address - Street 2:STE 200-3
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4570
Practice Address - Country:US
Practice Address - Phone:239-451-0087
Practice Address - Fax:239-225-7774
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2034106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist