Provider Demographics
NPI:1285152777
Name:KOPPLE, MELISSA JANETTE (LAC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANETTE
Last Name:KOPPLE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MISS
Other - First Name:MELISSA
Other - Middle Name:JANETTE
Other - Last Name:KOPPLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:470 6TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-2920
Mailing Address - Country:US
Mailing Address - Phone:541-708-1803
Mailing Address - Fax:
Practice Address - Street 1:470 6TH ST STE B
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-2920
Practice Address - Country:US
Practice Address - Phone:541-708-1803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC184838171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty