Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 2575 | CO |
NPI | 1003124850 |
---|---|
Provider Name | Melody Maria Michel |
First Address | Fort Collins, CO 80524-3220 |
Second Address | Fort Collins, CO 80524-3220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2010 |
Last Update Date | 14/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2575 | MASSAGE THERAPY LICENSE (01) | CO |