Provider Demographics
NPI:1013747153
Name:HUMPHREY, MELISA NOEL (COTA)
Entity type:Individual
Prefix:MRS
First Name:MELISA
Middle Name:NOEL
Last Name:HUMPHREY
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 1:8515 BOULEVARD 26 APT 1905
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-5655
Mailing Address - Country:US
Mailing Address - Phone:972-955-1695
Mailing Address - Fax:
Practice Address - Street 1:8515 BOULEVARD 26 APT 1905
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-5655
Practice Address - Country:US
Practice Address - Phone:972-955-1695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214680224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant