Healthcare Provider Details

I. General information

NPI: 1215432760
Provider Name (Legal Business Name): MELISSA HURLBURT OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 CHERRY ST
MILFORD CT
06460-3501
US

IV. Provider business mailing address

15 GREEN ACRES DR
WHITMAN MA
02382-1618
US

V. Phone/Fax

Practice location:
  • Phone: 203-874-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5746
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number13790
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: