Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0080 | AZ |
NPI | 1003956103 |
---|---|
Provider Name | Mrs. Melissa Michelle Hardy |
First Address | Phoenix, AZ 85024-4306 |
Second Address | Phoenix, AZ 85019-3206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
626765 | (05) | AZ |