Provider Demographics
NPI:1699874099
Name:BASSETT, MELODYE MOULTON (OTRL CHT)
Entity type:Individual
Prefix:MRS
First Name:MELODYE
Middle Name:MOULTON
Last Name:BASSETT
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3848 FAU BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6437
Mailing Address - Country:US
Mailing Address - Phone:561-432-0111
Mailing Address - Fax:561-432-1075
Practice Address - Street 1:3848 FAU BLVD STE 105
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6437
Practice Address - Country:US
Practice Address - Phone:561-395-2920
Practice Address - Fax:561-997-8929
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT1670225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889331400Medicaid
FL889331400Medicaid