MEDICARE: MELAINE KIMBERLY JOY AMERSON LMT

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	3750	AL

General Provider Information

NPI Number	:	1790358950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELAINE KIMBERLY JOY AMERSON LMT

Provider Business Mailing Address
First Line	:	7900 OLD MADISON PIKE APT 14005
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-2432
Country	:	US
Telephone Number	:	256-278-9470
Fax Number	:

Provider Business Practice Location Address
First Line	:	9694 MADISON BLVD STE A13
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-9140
Country	:	US
Telephone Number	:	256-517-2040
Fax Number	:

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

Provider Enumeration Date	:	07/23/2021
Last Update Date	:	08/28/2021

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