=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669824231
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA MAY ANDREWS LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2016
-----------------------------------------------------
Last Update Date | 07/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2019 9TH ST SUITE 4
-----------------------------------------------------
City | GREELEY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80631-3077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-978-5479
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 627 1/2 8TH AVE APT 17
-----------------------------------------------------
City | GREELEY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80631-3931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-978-5479
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT.0012692
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------