Provider Demographics
NPI:1063870202
Name:SCHENCK, MELODY (LMP)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:SCHENCK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15603 MAIN ST
Mailing Address - Street 2:B106
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-9003
Mailing Address - Country:US
Mailing Address - Phone:425-948-6495
Mailing Address - Fax:
Practice Address - Street 1:15603 MAIN ST
Practice Address - Street 2:B106
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-9003
Practice Address - Country:US
Practice Address - Phone:425-948-6495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60623802225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist