Provider Demographics
NPI:1780442160
Name:DOTY, MELANIE K (LMT)
Entity type:Individual
Prefix:MS
First Name:MELANIE
Middle Name:K
Last Name:DOTY
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 1:1728 SOUTHEAST BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-2108
Mailing Address - Country:US
Mailing Address - Phone:812-760-3535
Mailing Address - Fax:
Practice Address - Street 1:701 N WEINBACH AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-5990
Practice Address - Country:US
Practice Address - Phone:812-760-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT22308199225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist