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General NPI Number Information
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NPI Number | 1235630617
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Entity Type | Individual
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Provider Name | MELISSA HURST OT
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Gender | Female
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 02/22/2018
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Provider Practice Location Address
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Address Line | 3330 N GALLOWAY AVE # 304-86
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City | MESQUITE
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State | TX
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Zip | 75150-4728
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Country | US
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Telephone | 469-573-3402
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Fax | 469-533-1698
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Provider Business Mailing Address
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Address Line | 3330 N GALLOWAY AVE # 304-86
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City | MESQUITE
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State | TX
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Zip | 75150-4728
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Country | US
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Telephone | 469-573-3402
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Fax | 469-533-1698
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 106931
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License Number State | TX
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