Healthcare Provider Details

I. General information

NPI: 1043235294
Provider Name (Legal Business Name): MICHELLE MILLER MCLEMORE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA MICHELLE MILLER LMT

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 CHURCH ST
CAMDEN SC
29020-4211
US

IV. Provider business mailing address

526 OLD STAGECOACH RD
CAMDEN SC
29020-3200
US

V. Phone/Fax

Practice location:
  • Phone: 803-432-1478
  • Fax: 803-432-4212
Mailing address:
  • Phone: 803-243-9978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2604
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: