Provider Demographics
NPI:1235150012
Name:BILODEAU, MELISSA L (ATC)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:L
Last Name:BILODEAU
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GOODRICH AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-4636
Mailing Address - Country:US
Mailing Address - Phone:207-795-6562
Mailing Address - Fax:207-795-0101
Practice Address - Street 1:16 GOODRICH AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4636
Practice Address - Country:US
Practice Address - Phone:207-795-6562
Practice Address - Fax:207-795-0101
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT120174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist