Provider Demographics
NPI:1780890632
Name:HACKETT, MELISSA L (LMT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:L
Last Name:HACKETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 GROVE STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877
Mailing Address - Country:US
Mailing Address - Phone:203-431-8471
Mailing Address - Fax:203-438-9543
Practice Address - Street 1:90 GROVE STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877
Practice Address - Country:US
Practice Address - Phone:203-431-8471
Practice Address - Fax:203-438-9543
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT002235225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist