Provider Demographics
NPI:1366795189
Name:WEST, MELISSA ANN (LMT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:WEST
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 1:707 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4508
Mailing Address - Country:US
Mailing Address - Phone:503-883-0099
Mailing Address - Fax:503-465-4545
Practice Address - Street 1:707 E 5TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4508
Practice Address - Country:US
Practice Address - Phone:503-883-0099
Practice Address - Fax:503-465-4545
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19363225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist