Healthcare Provider Details

I. General information

NPI: 1710998273
Provider Name (Legal Business Name): MELODY A BARRETT L.M.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELODY A WAGNER

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 E. END RD
HOMER AK
99603
US

IV. Provider business mailing address

PO BOX 15073
FRITZ CREEK AK
99603-6073
US

V. Phone/Fax

Practice location:
  • Phone: 907-226-2228
  • Fax:
Mailing address:
  • Phone: 425-327-0979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00012526
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: