Provider Demographics
NPI:1003552506
Name:COALSON, MELISSA LEANNE (MED)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LEANNE
Last Name:COALSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 HUMMINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:SPOUT SPRING
Mailing Address - State:VA
Mailing Address - Zip Code:24593-2988
Mailing Address - Country:US
Mailing Address - Phone:434-665-5804
Mailing Address - Fax:
Practice Address - Street 1:1301 HUMMINGBIRD LN
Practice Address - Street 2:
Practice Address - City:SPOUT SPRING
Practice Address - State:VA
Practice Address - Zip Code:24593-2988
Practice Address - Country:US
Practice Address - Phone:434-665-5804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-07
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist