Provider Demographics
NPI:1992878052
Name:FISCHEL, MELISSA D (OT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:D
Last Name:FISCHEL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:D
Other - Last Name:FALLOWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:405 N WICKHAM RD
Mailing Address - Street 2:STE 103
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8628
Mailing Address - Country:US
Mailing Address - Phone:321-327-8509
Mailing Address - Fax:321-327-2130
Practice Address - Street 1:36 MAUCHLY
Practice Address - Street 2:STE A
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2393
Practice Address - Country:US
Practice Address - Phone:949-727-3315
Practice Address - Fax:949-727-3624
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT16358225XP0019X
CAOT 9434225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAO983YMedicare PIN