Healthcare Provider Details

I. General information

NPI: 1386113868
Provider Name (Legal Business Name): MELISSA MEARES COF, CMF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1473 DUCKWORTH ST
MORGANTON NC
28655-9381
US

IV. Provider business mailing address

1473 DUCKWORTH ST
MORGANTON NC
28655-9381
US

V. Phone/Fax

Practice location:
  • Phone: 856-298-3012
  • Fax:
Mailing address:
  • Phone: 828-234-0154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License NumberC51621
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberC51621
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: