Provider Demographics
NPI:1063716223
Name:HART, MELISSA JEAN (OTR/L)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:HART
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7761 W CHERRY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-8238
Mailing Address - Country:US
Mailing Address - Phone:623-256-5815
Mailing Address - Fax:623-334-0145
Practice Address - Street 1:10015 W ROYAL OAK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3164
Practice Address - Country:US
Practice Address - Phone:623-815-4156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2662225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist