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General NPI Number Information
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NPI Number | 1578321394
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Entity Type | Individual
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Provider Name | MELISSA SUE COHEN MMT, LE
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Gender | Female
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Dates
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Enumeration Date | 03/07/2024
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 1310 JOHN HARDEN DR STE B
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City | JACKSONVILLE
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State | AR
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Zip | 72076-3122
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Country | US
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Telephone | 501-515-4324
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Fax |
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Provider Business Mailing Address
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Address Line | 3208 VILLAGE EAST DR
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72120-2297
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 8915
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License Number State | AR
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