Provider Demographics
NPI:1740618933
Name:HILDEBRAND, MELISSA SUSAN (COTA/L)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUSAN
Last Name:HILDEBRAND
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 CREEKSIDE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-4033
Mailing Address - Country:US
Mailing Address - Phone:727-592-9100
Mailing Address - Fax:727-592-9109
Practice Address - Street 1:4902 CREEKSIDE DR
Practice Address - Street 2:SUITE A
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-4033
Practice Address - Country:US
Practice Address - Phone:727-592-9100
Practice Address - Fax:727-592-9109
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13013224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant