Provider Demographics
NPI:1861604308
Name:NGO, MELANIE DEVERA (REGISTERED OT)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:DEVERA
Last Name:NGO
Suffix:
Gender:F
Credentials:REGISTERED OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 JASPER AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-5333
Mailing Address - Country:US
Mailing Address - Phone:440-212-2805
Mailing Address - Fax:
Practice Address - Street 1:655 PARK CENTER DR
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-6957
Practice Address - Country:US
Practice Address - Phone:619-596-5500
Practice Address - Fax:619-596-5501
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH006515174400000X
IL056.007985174400000X
CA9372225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174400000XOther Service ProvidersSpecialist