Healthcare Provider Details

I. General information

NPI: 1982541066
Provider Name (Legal Business Name): ALYCIA MARY MELVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 N COLLEGE AVE
RIO GRANDE OH
45674-3131
US

IV. Provider business mailing address

19105 HUNTINGTON RD
GALLIPOLIS FERRY WV
25515-6157
US

V. Phone/Fax

Practice location:
  • Phone: 800-282-7201
  • Fax:
Mailing address:
  • Phone: 919-841-8061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: