Provider Demographics
NPI:1053858795
Name:HARLEY, MELANIE RENEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:RENEE
Last Name:HARLEY
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 1:706 N WINDOWPANE WAY
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-8979
Mailing Address - Country:US
Mailing Address - Phone:850-570-5167
Mailing Address - Fax:864-310-4415
Practice Address - Street 1:706 NORTH WINDOWPANE WAY
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-8979
Practice Address - Country:US
Practice Address - Phone:850-570-5167
Practice Address - Fax:864-310-4415
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2021-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 18182225X00000X
FLOT18182225X00000X
SC5697225X00000X
MD376976225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH4227Medicaid