Provider Demographics
NPI:1750933842
Name:MALIN, MELINDA B (DI)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:B
Last Name:MALIN
Suffix:
Gender:F
Credentials:DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 LEWIS HARGETT CIR STE 120
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3564
Mailing Address - Country:US
Mailing Address - Phone:859-983-1431
Mailing Address - Fax:
Practice Address - Street 1:4075 HOUSTON ANTIOCH RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40516-9504
Practice Address - Country:US
Practice Address - Phone:859-983-1431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist