Provider Demographics
NPI:1043303142
Name:MELAT, SUSAN LINDA (OTR, CVE, CHT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LINDA
Last Name:MELAT
Suffix:
Gender:F
Credentials:OTR, CVE, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 S TEJON ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-4049
Mailing Address - Country:US
Mailing Address - Phone:719-651-7830
Mailing Address - Fax:719-520-5089
Practice Address - Street 1:711 S TEJON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4049
Practice Address - Country:US
Practice Address - Phone:719-651-7830
Practice Address - Fax:719-520-5089
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC803360Medicare ID - Type Unspecified