Healthcare Provider Details

I. General information

NPI: 1669158366
Provider Name (Legal Business Name): MELISSA RIERSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20508 SW ROY ROGERS RD
SHERWOOD OR
97140-9932
US

IV. Provider business mailing address

110 W HAZELNUT DR
NEWBERG OR
97132-2806
US

V. Phone/Fax

Practice location:
  • Phone: 503-906-3585
  • Fax:
Mailing address:
  • Phone: 503-899-7611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number27695
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: