Provider Demographics
NPI:1467766766
Name:CLOSTER, MELISSA DEBRA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DEBRA
Last Name:CLOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:DEBRA
Other - Last Name:BLATT-CLOSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6 BURKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-2933
Mailing Address - Country:US
Mailing Address - Phone:914-674-1101
Mailing Address - Fax:
Practice Address - Street 1:6 BURKEWOOD RD
Practice Address - Street 2:
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-2933
Practice Address - Country:US
Practice Address - Phone:914-674-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006796-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist