Provider Demographics
NPI:1821619420
Name:MEADE, MELANIE DENISE (LMT)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:DENISE
Last Name:MEADE
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 1:6467 FARMDALE RD
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1305
Mailing Address - Country:US
Mailing Address - Phone:304-410-0502
Mailing Address - Fax:
Practice Address - Street 1:6467 FARMDALE RD
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1305
Practice Address - Country:US
Practice Address - Phone:304-410-0502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2016-3433225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty