Provider Demographics
NPI:1699267450
Name:MARTIN, MELISSA SPICER (CSA, LSA)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SPICER
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CSA, LSA
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:LEIGH
Other - Last Name:SPICER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSA, LSA
Mailing Address - Street 1:7324 SOUTHWEST FWY STE 1550
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2053
Mailing Address - Country:US
Mailing Address - Phone:832-436-4273
Mailing Address - Fax:832-436-4273
Practice Address - Street 1:7324 SOUTHWEST FWY STE 1550
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2053
Practice Address - Country:US
Practice Address - Phone:832-436-4273
Practice Address - Fax:832-436-4273
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA181522246ZC0007X
181522363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant