Provider Demographics
NPI:1922862432
Name:MICHAELS, LAURA MELISSA (CMP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MELISSA
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:CMP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MELISSA
Other - Last Name:MICHAELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMP
Mailing Address - Street 1:2570 BASIN ST
Mailing Address - Street 2:
Mailing Address - City:OCEANO
Mailing Address - State:CA
Mailing Address - Zip Code:93445-9100
Mailing Address - Country:US
Mailing Address - Phone:805-298-3949
Mailing Address - Fax:
Practice Address - Street 1:1390 PRICE ST
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2218
Practice Address - Country:US
Practice Address - Phone:805-298-3949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64531225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist