Provider Demographics
NPI:1972924397
Name:LOERA, MELISSA ELAINE (LMT, CD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ELAINE
Last Name:LOERA
Suffix:
Gender:F
Credentials:LMT, CD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ELAINE
Other - Last Name:HUSKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:2936 DREW ST
Mailing Address - Street 2:APT. 1323
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3055
Mailing Address - Country:US
Mailing Address - Phone:727-504-6219
Mailing Address - Fax:
Practice Address - Street 1:2936 DREW ST
Practice Address - Street 2:APT. 1323
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-3055
Practice Address - Country:US
Practice Address - Phone:727-504-6219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60968225700000X
374J00000X, 174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN