Healthcare Provider Details

I. General information

NPI: 1881838431
Provider Name (Legal Business Name): MELISSA BETH REYNERSON LMT, CYT, DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 S. CHUGACH ST.
PALMER AK
99645
US

IV. Provider business mailing address

1220 S. CHUGACH ST.
PALMER AK
99645
US

V. Phone/Fax

Practice location:
  • Phone: 907-745-3700
  • Fax:
Mailing address:
  • Phone: 907-745-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number905973
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number905973
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: