Provider Demographics
NPI:1366086795
Name:PLEMMONS, MELISSA (LMT)
Entity type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:PLEMMONS
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 1:1120 MAOHU ST
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-9461
Mailing Address - Country:US
Mailing Address - Phone:608-797-3600
Mailing Address - Fax:
Practice Address - Street 1:810 KOKOMO RD STE 159
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-5081
Practice Address - Country:US
Practice Address - Phone:808-214-8224
Practice Address - Fax:808-442-1140
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15452225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist