Provider Demographics
NPI:1831687490
Name:HARTY, MELISSA (COTA)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:HARTY
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 1:586 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75645-2900
Mailing Address - Country:US
Mailing Address - Phone:903-734-6274
Mailing Address - Fax:
Practice Address - Street 1:586 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75645-2900
Practice Address - Country:US
Practice Address - Phone:190-379-0143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-28
Last Update Date:2018-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant