Provider Demographics
NPI:1992193262
Name:MELROY, HASTI (COTA)
Entity Type:Individual
Prefix:MS
First Name:HASTI
Middle Name:
Last Name:MELROY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 LOS SERRANOS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3022
Mailing Address - Country:US
Mailing Address - Phone:714-488-4553
Mailing Address - Fax:
Practice Address - Street 1:4401 LOS SERRANOS BLVD
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-3022
Practice Address - Country:US
Practice Address - Phone:714-488-4553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2295224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant