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General NPI Number Information
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NPI Number | 1982234324
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Entity Type | Individual
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Provider Name | MELANIE TENNESSEE MOLINEAU LMT
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Gender | Female
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Dates
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Enumeration Date | 01/24/2020
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Last Update Date | 01/24/2020
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Provider Practice Location Address
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Address Line | 502 ALBANY AVE
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City | KINGSTON
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State | NY
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Zip | 12401-2141
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Country | US
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Telephone | 888-281-6685
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Fax | 845-201-0124
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Provider Business Mailing Address
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Address Line | PO BOX 84
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City | PORT EWEN
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State | NY
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Zip | 12466-0084
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Country | US
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Telephone | 888-281-6685
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Fax | 845-201-0124
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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 | 031054-1
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License Number State | NY
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