Provider Demographics
NPI:1275163974
Name:DAVIES, MELISSA K (LMT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:K
Last Name:DAVIES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HADLEY ST NE
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-3944
Mailing Address - Country:US
Mailing Address - Phone:509-393-9850
Mailing Address - Fax:
Practice Address - Street 1:6 1ST ST STE 12
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2247
Practice Address - Country:US
Practice Address - Phone:509-393-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
WAMA61028554225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula