Provider Demographics
NPI:1275729154
Name:MCKENZIE, MELISSA (LMP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:DEMARCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4220 A ST SE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-8620
Mailing Address - Country:US
Mailing Address - Phone:253-833-4800
Mailing Address - Fax:253-833-4801
Practice Address - Street 1:4220 A ST SE
Practice Address - Street 2:SUITE 103
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-8620
Practice Address - Country:US
Practice Address - Phone:253-833-4800
Practice Address - Fax:253-833-4801
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024461225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist