Provider Demographics
NPI:1285208900
Name:LIM, MELODY (OTR)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:
Other - Last Name:CHUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20363 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-2534
Mailing Address - Country:US
Mailing Address - Phone:818-688-1780
Mailing Address - Fax:
Practice Address - Street 1:3620 LOMITA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3938
Practice Address - Country:US
Practice Address - Phone:424-349-4703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16592225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist