Provider Demographics
NPI:1144597295
Name:OWENS, MELISSA LYN (MT-BC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:LYN
Last Name:OWENS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4713 BELFIELD CT
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-2126
Mailing Address - Country:US
Mailing Address - Phone:804-399-5897
Mailing Address - Fax:
Practice Address - Street 1:4713 BELFIELD CT
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23237-2126
Practice Address - Country:US
Practice Address - Phone:804-399-5897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist