Provider Demographics
NPI:1386403848
Name:FEDRAN, MELISSA LEE
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEE
Last Name:FEDRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 NECHES DR
Mailing Address - Street 2:
Mailing Address - City:MABANK
Mailing Address - State:TX
Mailing Address - Zip Code:75156-6626
Mailing Address - Country:US
Mailing Address - Phone:469-258-0100
Mailing Address - Fax:
Practice Address - Street 1:108 NECHES DR
Practice Address - Street 2:
Practice Address - City:MABANK
Practice Address - State:TX
Practice Address - Zip Code:75156-6626
Practice Address - Country:US
Practice Address - Phone:469-258-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT107009225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist