Provider Demographics
NPI:1104158203
Name:MELTON, PATRICIA GAIL (LMBT)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:GAIL
Last Name:MELTON
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MACS LN
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-6919
Mailing Address - Country:US
Mailing Address - Phone:828-734-0687
Mailing Address - Fax:828-926-1649
Practice Address - Street 1:32 FELMET ST
Practice Address - Street 2:SUITE C
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3605
Practice Address - Country:US
Practice Address - Phone:828-734-0687
Practice Address - Fax:828-926-1649
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5914225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist