Provider Demographics
NPI:1144974825
Name:LAROCHELLE, MELODY ELIZABETH (LMT)
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:ELIZABETH
Last Name:LAROCHELLE
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 1:1801 SUMMIT PLACE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2428
Mailing Address - Country:US
Mailing Address - Phone:678-913-7213
Mailing Address - Fax:
Practice Address - Street 1:4343 SHALLOWFORD RD STE 560
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5072
Practice Address - Country:US
Practice Address - Phone:404-981-3941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT012901225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist