Provider Demographics
NPI:1851493407
Name:MOSKOWITZ, MELANIE (OTR)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:MOSKOWITZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6388 BRIDGEPORT LN
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6533
Mailing Address - Country:US
Mailing Address - Phone:561-968-8943
Mailing Address - Fax:561-966-3718
Practice Address - Street 1:499 E PALMETTO PARK RD
Practice Address - Street 2:STE 212
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5080
Practice Address - Country:US
Practice Address - Phone:561-596-0906
Practice Address - Fax:561-966-3718
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10737225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP76392Medicare UPIN
FLE8824ZMedicare ID - Type UnspecifiedPROVIDER NUMBER