Provider Demographics
NPI:1376616649
Name:WHEELHOUSE, MELANIE EILEEN (LMT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:EILEEN
Last Name:WHEELHOUSE
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 1:150 E CLARENDON ST
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-2428
Mailing Address - Country:US
Mailing Address - Phone:503-804-7750
Mailing Address - Fax:
Practice Address - Street 1:150 E CLARENDON ST
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2428
Practice Address - Country:US
Practice Address - Phone:503-804-7750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8137225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist