Provider Demographics
NPI:1376784348
Name:ROEDER, MELISSA RENEE (LMP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENEE
Last Name:ROEDER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 SOUTH GEIGER BLVD.
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224
Mailing Address - Country:US
Mailing Address - Phone:509-993-4478
Mailing Address - Fax:509-838-6416
Practice Address - Street 1:3711 S GEIGER BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-5416
Practice Address - Country:US
Practice Address - Phone:509-993-4478
Practice Address - Fax:509-838-6416
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00013040225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist