Provider Demographics
NPI:1760295653
Name:OSWALD, MELISSA EILEEN (CMT, LMT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:EILEEN
Last Name:OSWALD
Suffix:
Gender:F
Credentials:CMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 SUNSET DR # 119
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-2340
Mailing Address - Country:US
Mailing Address - Phone:530-513-8109
Mailing Address - Fax:
Practice Address - Street 1:160 SUNSET DR # 119
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-2340
Practice Address - Country:US
Practice Address - Phone:530-513-8109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96601225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist