Healthcare Provider Details

I. General information

NPI: 1093417867
Provider Name (Legal Business Name): MELISSA MAY MOUA LMT, EDD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 MAIN ST STE A
MILES CITY MT
59301-3345
US

IV. Provider business mailing address

1807 N STREVELL AVE
MILES CITY MT
59301-5426
US

V. Phone/Fax

Practice location:
  • Phone: 406-234-6467
  • Fax:
Mailing address:
  • Phone: 785-226-0554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22308
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: