Provider Demographics
NPI:1235630617
Name:HURST, MELISSA (OT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HURST
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 N GALLOWAY AVE # 304-86
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4728
Mailing Address - Country:US
Mailing Address - Phone:469-573-3402
Mailing Address - Fax:469-533-1698
Practice Address - Street 1:3330 N GALLOWAY AVE # 304-86
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4728
Practice Address - Country:US
Practice Address - Phone:469-573-3402
Practice Address - Fax:469-533-1698
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106931225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics