Provider Demographics
NPI:1881054690
Name:IEHL, MELISSA (MS, ATC, LAT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:IEHL
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 ELM ST
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:IA
Mailing Address - Zip Code:50588-7737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:211 ELM ST
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:IA
Practice Address - Zip Code:50588-7737
Practice Address - Country:US
Practice Address - Phone:402-910-8243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000973171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor