Provider Demographics
NPI:1649545179
Name:FOUTS, MELISSA A (COF)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
Last Name:FOUTS
Suffix:
Gender:F
Credentials:COF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FRANKLIN PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-3204
Mailing Address - Country:US
Mailing Address - Phone:828-524-0156
Mailing Address - Fax:828-524-3022
Practice Address - Street 1:20 FRANKLIN PLAZA DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-3204
Practice Address - Country:US
Practice Address - Phone:828-524-0156
Practice Address - Fax:828-524-3022
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC50396225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC50396OtherCERTIFIED ORTHOTIC FITTER