Provider Demographics
NPI:1811065261
Name:NELSON, MELODY W (MT-BC)
Entity type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:W
Last Name:NELSON
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 SUNSET STREET
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249
Mailing Address - Country:US
Mailing Address - Phone:209-754-1567
Mailing Address - Fax:
Practice Address - Street 1:379 SUNSET ST
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249-9608
Practice Address - Country:US
Practice Address - Phone:209-754-1567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist