Provider Demographics
NPI:1114558665
Name:HANSON, MELISSA KAY (LOTR)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:KAY
Last Name:HANSON
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:KAY
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2509 HARTS BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-6253
Mailing Address - Country:US
Mailing Address - Phone:936-572-7117
Mailing Address - Fax:
Practice Address - Street 1:2509 HARTS BLUFF RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052-6253
Practice Address - Country:US
Practice Address - Phone:936-572-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120495225X00000X
LA321847225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist