Provider Demographics
NPI:1992983779
Name:BAZEMORE, MELINDA (LMT)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:BAZEMORE
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 1:2567 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44233-9561
Mailing Address - Country:US
Mailing Address - Phone:330-558-0100
Mailing Address - Fax:330-558-0110
Practice Address - Street 1:2567 CENTER RD
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:OH
Practice Address - Zip Code:44233-9561
Practice Address - Country:US
Practice Address - Phone:330-558-0100
Practice Address - Fax:330-558-0110
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.016065225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist