=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952128910
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MELISSA KARASEK LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2024
-----------------------------------------------------
Last Update Date | 09/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6910 N MAIN ST UNIT 2
-----------------------------------------------------
City | GRANGER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46530-9681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-208-3815
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 52890 SWANSON DR
-----------------------------------------------------
City | SOUTH BEND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46635-1235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-241-1257
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/LICENSED MASSAGE THERAPIST
-----------------------------------------------------
Name | MS. MELISSA ELIZABETH KARASEK
-----------------------------------------------------
Credential | LMT
-----------------------------------------------------
Telephone | 574-208-3815
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------