Provider Demographics
NPI:1811385685
Name:OLIVER, MELANIE ANN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ANN
Last Name:OLIVER
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 1:225 W EL NORTE PKWY
Mailing Address - Street 2:#238
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-2565
Mailing Address - Country:US
Mailing Address - Phone:760-294-4821
Mailing Address - Fax:
Practice Address - Street 1:225 W EL NORTE PKWY
Practice Address - Street 2:#238
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-2565
Practice Address - Country:US
Practice Address - Phone:760-294-4821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2673224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant