Provider Demographics
NPI:1093417867
Name:MOUA, MELISSA MAY (LMT, EDD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MAY
Last Name:MOUA
Suffix:
Gender:F
Credentials:LMT, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 N STREVELL AVE
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-5426
Mailing Address - Country:US
Mailing Address - Phone:785-226-0554
Mailing Address - Fax:
Practice Address - Street 1:907 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-3345
Practice Address - Country:US
Practice Address - Phone:406-234-6467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT22308225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist