Provider Demographics
NPI:1265906317
Name:MACKEY, MELISSA JEAN
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JEAN
Last Name:MACKEY
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 1:101 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08030-2628
Mailing Address - Country:US
Mailing Address - Phone:609-238-7132
Mailing Address - Fax:
Practice Address - Street 1:101 4TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLAWN
Practice Address - State:NJ
Practice Address - Zip Code:08030-2628
Practice Address - Country:US
Practice Address - Phone:609-238-7132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer