Provider Demographics
NPI:1033462379
Name:SNOW, MELISSA A (LMT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:SNOW
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04021-4024
Mailing Address - Country:US
Mailing Address - Phone:207-615-8563
Mailing Address - Fax:
Practice Address - Street 1:84 COVE ST
Practice Address - Street 2:#1
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2514
Practice Address - Country:US
Practice Address - Phone:207-552-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT4849225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist