Provider Demographics
NPI:1932388345
Name:KELLER, MELANIE S (LMP)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:S
Last Name:KELLER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:S
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30476 154TH PL SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042
Mailing Address - Country:US
Mailing Address - Phone:253-221-0190
Mailing Address - Fax:253-631-5882
Practice Address - Street 1:30476 154TH PL SE
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-5514
Practice Address - Country:US
Practice Address - Phone:253-221-0190
Practice Address - Fax:253-631-5882
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00015536225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist