Healthcare Provider Details

I. General information

NPI: 1699610410
Provider Name (Legal Business Name): MELISSA I EMERSON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 GREEN MEADOW RD
WILLIAMS OR
97544-9539
US

IV. Provider business mailing address

210 GREEN MEADOW RD
WILLIAMS OR
97544-9539
US

V. Phone/Fax

Practice location:
  • Phone: 541-287-1459
  • Fax:
Mailing address:
  • Phone: 541-287-1459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number15458
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: