Provider Demographics
NPI:1710015136
Name:KOHLER, MELISSA G (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:G
Last Name:KOHLER
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3624 ENSIGN RD. NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5081
Mailing Address - Country:US
Mailing Address - Phone:360-491-4131
Mailing Address - Fax:360-570-2010
Practice Address - Street 1:3624 ENSIGN RD NE
Practice Address - Street 2:SUITE B
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5074
Practice Address - Country:US
Practice Address - Phone:360-491-4131
Practice Address - Fax:360-570-2010
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002374171100000X
WANT00001338175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist