Provider Demographics
NPI:1518015148
Name:FOWLER, MELISSA (ATC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8697 COOLEY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-4725
Mailing Address - Country:US
Mailing Address - Phone:248-366-0123
Mailing Address - Fax:248-366-0122
Practice Address - Street 1:39830 GRAND RIVER AVE
Practice Address - Street 2:SUITE B3
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2140
Practice Address - Country:US
Practice Address - Phone:248-473-5600
Practice Address - Fax:248-473-8480
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer