Provider Demographics
NPI:1477845139
Name:HAECKEL, MELISSA (MELISSA HAECKEL)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HAECKEL
Suffix:
Gender:F
Credentials:MELISSA HAECKEL
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:HAECKEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MELISSA HAECKEL, LMT
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:NEHALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97131-0031
Mailing Address - Country:US
Mailing Address - Phone:503-729-8150
Mailing Address - Fax:
Practice Address - Street 1:1355 SOUTH HEMLOCK STREET
Practice Address - Street 2:
Practice Address - City:CANNON BEACH
Practice Address - State:OR
Practice Address - Zip Code:97138
Practice Address - Country:US
Practice Address - Phone:503-436-2255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR14599225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist