Provider Demographics
NPI:1871004713
Name:STEVENS, MELATI OLIVIA (DAOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:MELATI
Middle Name:OLIVIA
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DAOM, LAC
Other - Prefix:DR
Other - First Name:MELATI
Other - Middle Name:
Other - Last Name:OLIVIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DAOM, LAC
Mailing Address - Street 1:1107 ELIZABETH ST APT 201
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-3268
Mailing Address - Country:US
Mailing Address - Phone:720-351-0081
Mailing Address - Fax:
Practice Address - Street 1:1601 E 19TH AVE STE 3025
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1220
Practice Address - Country:US
Practice Address - Phone:303-788-9399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2282171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist