Provider Demographics
NPI:1780861435
Name:SINCLAIR, MELISSA DIANE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:DIANE
Last Name:SINCLAIR
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 1:2447 SE 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-1108
Mailing Address - Country:US
Mailing Address - Phone:503-380-5588
Mailing Address - Fax:
Practice Address - Street 1:211 NE 28TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3300
Practice Address - Country:US
Practice Address - Phone:503-245-5993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11886225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist