Provider Demographics
NPI:1700120177
Name:MARKS, MELISSA M (LMT, MMP, NCTMB)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:MARKS
Suffix:
Gender:F
Credentials:LMT, MMP, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1581
Mailing Address - Street 2:
Mailing Address - City:WAITSFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05673-1581
Mailing Address - Country:US
Mailing Address - Phone:518-755-5688
Mailing Address - Fax:
Practice Address - Street 1:1490 LINCOLN GAP RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:VT
Practice Address - Zip Code:05674-9826
Practice Address - Country:US
Practice Address - Phone:518-755-5688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-25
Last Update Date:2012-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025248225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist