Provider Demographics
NPI:1659055978
Name:MELVIN, BRENDAN LANE (MSAT)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:LANE
Last Name:MELVIN
Suffix:
Gender:M
Credentials:MSAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ONAGA
Mailing Address - State:KS
Mailing Address - Zip Code:66521-9569
Mailing Address - Country:US
Mailing Address - Phone:785-844-3996
Mailing Address - Fax:
Practice Address - Street 1:214 E 8TH ST
Practice Address - Street 2:
Practice Address - City:ONAGA
Practice Address - State:KS
Practice Address - Zip Code:66521-9569
Practice Address - Country:US
Practice Address - Phone:785-844-3996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer