Provider Demographics
NPI:1003283094
Name:MALITO, MELISSA ANNE (COTA/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:MALITO
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DEBARTOLO PL
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-7011
Mailing Address - Country:US
Mailing Address - Phone:330-965-7828
Mailing Address - Fax:
Practice Address - Street 1:100 DEBARTOLO PL
Practice Address - Street 2:SUITE 220
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-7011
Practice Address - Country:US
Practice Address - Phone:330-965-7828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH02251390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program