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NPI Code Detail

MEDICARE: MELEANE BALABAGNO OTA

MEDICARE: MELEANE BALABAGNO OTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy AssistantOTA001540GA

General Provider Information

NPI Number : 1548662547
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELEANE BALABAGNO OTA
Provider Business Mailing Address
First Line : 127 CARTER ST
Second Line :
City : RICHMOND HILL
State : GA
Zip : 31324-3753
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 127 CARTER ST
Second Line :
City : RICHMOND HILL
State : GA
Zip : 31324-3753
Country : US
Telephone Number : 912-756-6131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2014
Last Update Date : 09/22/2014

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Directions to “ MELEANE BALABAGNO OTA” Practice Location

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