Provider Demographics
NPI:1528347226
Name:NELMARK, MELORA LINDSAY (LMT)
Entity type:Individual
Prefix:
First Name:MELORA
Middle Name:LINDSAY
Last Name:NELMARK
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 1:1524 S GREEN BAY RD
Mailing Address - Street 2:103
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-5788
Mailing Address - Country:US
Mailing Address - Phone:262-884-7580
Mailing Address - Fax:262-884-7980
Practice Address - Street 1:1524 S GREEN BAY RD
Practice Address - Street 2:103
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-5788
Practice Address - Country:US
Practice Address - Phone:262-884-7580
Practice Address - Fax:262-884-7980
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2495-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist