Healthcare Provider Details

I. General information

NPI: 1366963605
Provider Name (Legal Business Name): MELANIE SUZANNE BALLIET OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELANIE HARKNESS COTA/L

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LONG BEACH BLVD STE 700
LONG BEACH CA
90807-2000
US

IV. Provider business mailing address

7374 COPTER LN
MILTON FL
32570-6211
US

V. Phone/Fax

Practice location:
  • Phone: 818-894-2273
  • Fax: 818-357-2505
Mailing address:
  • Phone: 484-464-3156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number27217
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT22688
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: