Provider Demographics
NPI:1518222645
Name:MELL, LAUREN T (LMT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:T
Last Name:MELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 STIRLING ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-1408
Mailing Address - Country:US
Mailing Address - Phone:978-807-2732
Mailing Address - Fax:
Practice Address - Street 1:38 MONTVALE AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-2446
Practice Address - Country:US
Practice Address - Phone:978-807-2732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-04
Last Update Date:2012-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10555225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist