MEDICARE: MELODY CHEONOA ROBB LMP

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	174400000X	Specialist	MA60069656	WA

General Provider Information

NPI Number	:	1801035837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODY CHEONOA ROBB LMP

Provider Business Mailing Address
First Line	:	708 BROADWAY
Second Line	:	SUITE 103
City	:	TACOMA
State	:	WA
Zip	:	98402-3778
Country	:	US
Telephone Number	:	253-284-5790
Fax Number	:

Provider Business Practice Location Address
First Line	:	708 BROADWAY
Second Line	:	SUITE 103
City	:	TACOMA
State	:	WA
Zip	:	98402-3778
Country	:	US
Telephone Number	:	253-284-5790
Fax Number	:

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

Provider Enumeration Date	:	02/14/2009
Last Update Date	:	02/14/2009

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