Healthcare Provider Details

I. General information

NPI: 1023679461
Provider Name (Legal Business Name): MELANIE RYDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WASHINGTON ST
TAUNTON MA
02780-3960
US

IV. Provider business mailing address

42 STONE HEDGE LN
ATTLEBORO MA
02703-4343
US

V. Phone/Fax

Practice location:
  • Phone: 508-828-9116
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: