Provider Demographics
NPI:1790925246
Name:BECK, MELISSA CAROLINE (LMT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:CAROLINE
Last Name:BECK
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 1:2700 S LIONS AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7682
Mailing Address - Country:US
Mailing Address - Phone:918-812-0489
Mailing Address - Fax:918-449-8888
Practice Address - Street 1:2700 S LIONS AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7682
Practice Address - Country:US
Practice Address - Phone:918-812-0489
Practice Address - Fax:918-449-8888
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK08 00016742225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist