Provider Demographics
NPI:1376744383
Name:LINDSEY, MELISSA SUE (OTRL)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:LINDSEY
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 BROADWAY APT 415
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-3905
Mailing Address - Country:US
Mailing Address - Phone:253-507-4217
Mailing Address - Fax:
Practice Address - Street 1:3435 MARTIN WAY E STE C
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5071
Practice Address - Country:US
Practice Address - Phone:360-923-5840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00004426174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist