Healthcare Provider Details

I. General information

NPI: 1689116345
Provider Name (Legal Business Name): MELISSA STRONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2016
Last Update Date: 11/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41521 W 11 MILE RD
NOVI MI
48375-1803
US

IV. Provider business mailing address

718 RANDOLPH ST
ANGOLA IN
46703-1655
US

V. Phone/Fax

Practice location:
  • Phone: 248-299-0030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: