Provider Demographics
NPI:1184273054
Name:LAWRENCE, MELINDA SUE (OTR/L)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:SUE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 HIGH POINT RD
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-2007
Mailing Address - Country:US
Mailing Address - Phone:906-286-3130
Mailing Address - Fax:
Practice Address - Street 1:1 BOWEN DR STE 1
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2902
Practice Address - Country:US
Practice Address - Phone:305-704-0313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20318225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist