Provider Demographics
NPI:1588424048
Name:COLE, MELISSA M (MT-BC, WMTR)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:COLE
Suffix:
Gender:F
Credentials:MT-BC, WMTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 PARK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOREB
Mailing Address - State:WI
Mailing Address - Zip Code:53572-1635
Mailing Address - Country:US
Mailing Address - Phone:608-432-5023
Mailing Address - Fax:
Practice Address - Street 1:406 PARK VIEW DR
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-1635
Practice Address - Country:US
Practice Address - Phone:608-432-5023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI07204225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist