Provider Demographics
NPI:1194260166
Name:BOWN, MELISSA (ATC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:BOWN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7615
Mailing Address - Country:US
Mailing Address - Phone:248-875-3184
Mailing Address - Fax:
Practice Address - Street 1:2277 MARTHA BERRY HWY NW
Practice Address - Street 2:
Practice Address - City:MOUNT BERRY
Practice Address - State:GA
Practice Address - Zip Code:30149-9707
Practice Address - Country:US
Practice Address - Phone:248-875-3184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-30
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0028102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer