Provider Demographics
NPI:1639491913
Name:RUFFIN, MELODY (LMP)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 S 256TH ST
Mailing Address - Street 2:L102
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-6545
Mailing Address - Country:US
Mailing Address - Phone:253-528-3239
Mailing Address - Fax:
Practice Address - Street 1:205 E MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5465
Practice Address - Country:US
Practice Address - Phone:253-528-3239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-27
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA6029758225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist