Provider Demographics
NPI:1013153766
Name:GANDY, MELODY MAURINE (LMT)
Entity Type:Individual
Prefix:PROF
First Name:MELODY
Middle Name:MAURINE
Last Name:GANDY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MELODY
Other - Middle Name:MAURINE
Other - Last Name:MORTON GANDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:1800 LAKEWOOD CT SPC 175
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-1676
Mailing Address - Country:US
Mailing Address - Phone:541-543-8405
Mailing Address - Fax:541-689-2231
Practice Address - Street 1:1800 LAKEWOOD CT SPC 175
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-1676
Practice Address - Country:US
Practice Address - Phone:541-543-8405
Practice Address - Fax:541-689-2231
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-31
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7288174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist