Provider Demographics
NPI:1982249439
Name:CHARRON, MELISSA KAYE (ATC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:KAYE
Last Name:CHARRON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15927 52ND ST E APT C
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-3151
Mailing Address - Country:US
Mailing Address - Phone:253-365-1846
Mailing Address - Fax:
Practice Address - Street 1:10004 204TH AVE E STE 3100
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-6540
Practice Address - Country:US
Practice Address - Phone:253-863-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer