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General NPI Number Information
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NPI Number | 1982249439
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Entity Type | Individual
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Provider Name | MELISSA KAYE CHARRON ATC
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Gender | Female
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Dates
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Enumeration Date | 11/07/2019
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Last Update Date | 11/07/2019
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Provider Practice Location Address
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Address Line | 10004 204TH AVE E STE 3100
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City | BONNEY LAKE
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State | WA
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Zip | 98391-6540
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Country | US
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Telephone | 253-863-7510
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Fax |
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Provider Business Mailing Address
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Address Line | 15927 52ND ST E APT C
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City | SUMNER
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State | WA
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Zip | 98390-3151
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Country | US
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Telephone | 253-365-1846
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | WA
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