Provider Demographics
NPI:1639742976
Name:MELICK, BRITTANI (COTA/ L)
Entity Type:Individual
Prefix:
First Name:BRITTANI
Middle Name:
Last Name:MELICK
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 1:6202 CYPRESS POINT DR APT 3
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-5841
Mailing Address - Country:US
Mailing Address - Phone:740-348-6843
Mailing Address - Fax:
Practice Address - Street 1:6202 CYPRESS POINT DR APT 3
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-5841
Practice Address - Country:US
Practice Address - Phone:740-348-6843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17952224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant