Provider Demographics
NPI:1619270808
Name:COREY, MELINDA DEE (LMT)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:DEE
Last Name:COREY
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 1:1271 NE DAWSON DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8380
Mailing Address - Country:US
Mailing Address - Phone:503-930-2736
Mailing Address - Fax:
Practice Address - Street 1:161 S ELM ST
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-1070
Practice Address - Country:US
Practice Address - Phone:503-930-2736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5351225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist