Provider Demographics
NPI:1922735794
Name:COLLIER, MELODY JOANN
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:JOANN
Last Name:COLLIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 N DAVIS AVE APT 4B
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3443
Mailing Address - Country:US
Mailing Address - Phone:918-381-1146
Mailing Address - Fax:
Practice Address - Street 1:306 N DAVIS AVE APT 4B
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3443
Practice Address - Country:US
Practice Address - Phone:918-381-1146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist