MEDICARE: MELISSA A GARVIN LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	2016-3385	WV

General Provider Information

NPI Number	:	1942704796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA A GARVIN LMT

Provider Business Mailing Address
First Line	:	473 NICHOLAS FARM RD
Second Line	:
City	:	GRAFTON
State	:	WV
Zip	:	26354-7307
Country	:	US
Telephone Number	:	314-323-7561
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 LINCOLN ST.
Second Line	:
City	:	GRAFTON
State	:	WV
Zip	:	26354-1562
Country	:	US
Telephone Number	:	314-323-7561
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2018
Last Update Date	:	03/19/2018

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