Provider Demographics
NPI:1437321015
Name:SIMON, MELISSA (LMT(MASSAGE THERAPIS)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:LMT(MASSAGE THERAPIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 MONROE ST
Mailing Address - Street 2:SUITE A-205
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2731
Mailing Address - Country:US
Mailing Address - Phone:419-472-2280
Mailing Address - Fax:419-292-0159
Practice Address - Street 1:5600 MONROE ST
Practice Address - Street 2:SUITE A-205
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2731
Practice Address - Country:US
Practice Address - Phone:419-472-2280
Practice Address - Fax:419-292-0159
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33-010278225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist