Provider Demographics
NPI:1881766715
Name:HASSENPLUG, CHARDA MELODY (OTA)
Entity type:Individual
Prefix:MRS
First Name:CHARDA
Middle Name:MELODY
Last Name:HASSENPLUG
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:MISS
Other - First Name:CHARDA
Other - Middle Name:MELODY
Other - Last Name:HRITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTA
Mailing Address - Street 1:415 DEVLIN ST
Mailing Address - Street 2:
Mailing Address - City:GALLITZIN
Mailing Address - State:PA
Mailing Address - Zip Code:16641-1210
Mailing Address - Country:US
Mailing Address - Phone:814-327-9119
Mailing Address - Fax:
Practice Address - Street 1:807 GOUCHER ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-2942
Practice Address - Country:US
Practice Address - Phone:814-255-4921
Practice Address - Fax:814-255-4921
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP006133224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant