Provider Demographics
NPI:1295492940
Name:HARVEY, MELISSA KAY (MA 61148969)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAY
Last Name:HARVEY
Suffix:
Gender:F
Credentials:MA 61148969
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KAY
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MASSAGE THERAPY
Mailing Address - Street 1:408 S ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-9310
Mailing Address - Country:US
Mailing Address - Phone:509-350-3889
Mailing Address - Fax:
Practice Address - Street 1:1321 N COLUMBIA CENTER BLVD
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2455
Practice Address - Country:US
Practice Address - Phone:509-820-2928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61148969225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty