Provider Demographics
NPI:1215709100
Name:PUGH, MELISSA DEVINE
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DEVINE
Last Name:PUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 812 BOX 344
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09627
Mailing Address - Country:IT
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:95121 VILLAGGIO DELGI ULIVI
Practice Address - Street 2:
Practice Address - City:SIGONELLA
Practice Address - State:AE
Practice Address - Zip Code:09627
Practice Address - Country:IT
Practice Address - Phone:314-624-4568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18919225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist