Provider Demographics
NPI:1346506813
Name:RUDD, MELISSA ANNE (ATC, AT/L)
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:ANNE
Last Name:RUDD
Suffix:
Gender:F
Credentials:ATC, AT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:STEPTOE
Mailing Address - State:WA
Mailing Address - Zip Code:99174-3073
Mailing Address - Country:US
Mailing Address - Phone:509-592-8261
Mailing Address - Fax:
Practice Address - Street 1:13 CASHUP AVE.
Practice Address - Street 2:
Practice Address - City:STEPTOE
Practice Address - State:WA
Practice Address - Zip Code:99174-3073
Practice Address - Country:US
Practice Address - Phone:509-592-8261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer