MEDICARE: MELISSA WOLF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	26641	OR

General Provider Information

NPI Number	:	1609513209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA WOLF

Provider Business Mailing Address
First Line	:	2660 W MAIN ST APT 12
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97501-3188
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 S GRAPE ST
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97501-3147
Country	:	US
Telephone Number	:	541-261-8625
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	05/16/2022

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Directions to “ MELISSA WOLF ” Practice Location

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