Provider Demographics
NPI:1912274390
Name:CLINE, MELANIE A (LMT)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:A
Last Name:CLINE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:WV
Mailing Address - Zip Code:24811-0143
Mailing Address - Country:US
Mailing Address - Phone:304-938-9189
Mailing Address - Fax:
Practice Address - Street 1:8997 MOUNTAINEER RD.
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:WV
Practice Address - Zip Code:24811-0143
Practice Address - Country:US
Practice Address - Phone:304-938-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2011-2874225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist