Provider Demographics
NPI:1871853945
Name:POTTS, MELISSA JOY (MT-BC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:JOY
Last Name:POTTS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4651 PRINCESS COURT NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-2241
Mailing Address - Country:US
Mailing Address - Phone:503-383-6012
Mailing Address - Fax:
Practice Address - Street 1:4651 PRINCESS CT NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-2241
Practice Address - Country:US
Practice Address - Phone:503-383-6012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist