Provider Demographics
NPI:1396449732
Name:MELENDEZ PEREZ, STHEFANY (OTR)
Entity type:Individual
Prefix:
First Name:STHEFANY
Middle Name:
Last Name:MELENDEZ PEREZ
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 1:236 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5691
Mailing Address - Country:US
Mailing Address - Phone:352-683-2120
Mailing Address - Fax:352-683-9232
Practice Address - Street 1:236 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5691
Practice Address - Country:US
Practice Address - Phone:352-683-2120
Practice Address - Fax:352-683-9232
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24127225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty