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General NPI Number Information
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NPI Number | 1669737532
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Entity Type | Individual
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Provider Name | MELISSA MARIE WICKEY LMT, EAMP
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Gender | Female
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Dates
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Enumeration Date | 07/06/2012
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 50 MALCOM ST STE 711
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City | FRIDAY HARBOR
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State | WA
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Zip | 98250-7270
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Country | US
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Telephone | 360-362-9540
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Fax |
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Provider Business Mailing Address
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Address Line | 618 FINNEGAN WAY
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City | FRIDAY HARBOR
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State | WA
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Zip | 98250
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Country | US
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Telephone | 360-362-9540
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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 | MA60644137
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 10981
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC60684688
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License Number State | WA
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