Provider Demographics
NPI:1003052325
Name:BATTY, MELANIE ALEISA (LMP)
Entity Type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:ALEISA
Last Name:BATTY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5849 TACOMA MALL BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-6905
Mailing Address - Country:US
Mailing Address - Phone:253-475-6779
Mailing Address - Fax:253-475-7005
Practice Address - Street 1:5849 TACOMA MALL BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-6905
Practice Address - Country:US
Practice Address - Phone:253-475-6779
Practice Address - Fax:253-475-7005
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60058035171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor