Provider Demographics
NPI:1174038764
Name:RICHIE, MELISSA THEIGE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:THEIGE
Last Name:RICHIE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 HIGHLAND ST.
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAMILTON
Mailing Address - State:MA
Mailing Address - Zip Code:01982-1399
Mailing Address - Country:US
Mailing Address - Phone:978-468-4415
Mailing Address - Fax:978-468-3758
Practice Address - Street 1:537 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:SOUTH HAMILTON
Practice Address - State:MA
Practice Address - Zip Code:01982-1316
Practice Address - Country:US
Practice Address - Phone:978-468-4415
Practice Address - Fax:978-468-3758
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer