Provider Demographics
NPI:1942863857
Name:NOSKOWIAK, MELANIE
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:NOSKOWIAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:NOSKOWIAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAT, LAT, ATC
Mailing Address - Street 1:3750 COPPER OAK CIR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-7585
Mailing Address - Country:US
Mailing Address - Phone:920-562-5464
Mailing Address - Fax:
Practice Address - Street 1:12500 S APOPKA VINELAND RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-6723
Practice Address - Country:US
Practice Address - Phone:407-201-0914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL49512255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer