Provider Demographics
NPI:1366963605
Name:BALLIET, MELANIE (OTR/L)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:BALLIET
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:HARKNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA/L
Mailing Address - Street 1:7374 COPTER LN
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-6211
Mailing Address - Country:US
Mailing Address - Phone:484-464-3156
Mailing Address - Fax:
Practice Address - Street 1:7374 COPTER LN
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-6211
Practice Address - Country:US
Practice Address - Phone:484-464-3156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-27
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT22688225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist