Basic Information
| Provider Information | |||||||||
| NPI: | 1699874099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BASSETT | ||||||||
| FirstName: | MELODYE | ||||||||
| MiddleName: | MOULTON | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | OTRL CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3848 FAU BLVD | ||||||||
| Address2: | STE 105 | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334316437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614320111 | ||||||||
| FaxNumber: | 5614321075 | ||||||||
| Practice Location | |||||||||
| Address1: | 3848 FAU BLVD STE 105 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334316437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613952920 | ||||||||
| FaxNumber: | 5619978929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2006 | ||||||||
| LastUpdateDate: | 04/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OT1670 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 889331400 | 05 | FL | MEDICAID |