Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PT005740 | OH |
Y | 213ES0000X | Sports Medicine | PT005740 | OH |
NPI | 1043307333 |
---|---|
Provider Name | Ms. Melissa Mae Waddell |
First Address | Peebles, OH 45660-1049 |
Second Address | Peebles, OH 45660-1049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 25/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31-1448551 | TAX ID (01) | OH |