Provider Demographics
NPI:1104271592
Name:PATTON, MELANIE (OTR/L)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:PATTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17253 PALISADES CIR
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2151
Mailing Address - Country:US
Mailing Address - Phone:310-927-6735
Mailing Address - Fax:
Practice Address - Street 1:17253 PALISADES CIR
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-2151
Practice Address - Country:US
Practice Address - Phone:310-927-6735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5062225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist