Provider Demographics
NPI:1053148734
Name:CARLTON, MELISSA P (LMT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:P
Last Name:CARLTON
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 1:20508 SW ROY ROGERS RD # C116
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9932
Mailing Address - Country:US
Mailing Address - Phone:503-906-3585
Mailing Address - Fax:503-906-3586
Practice Address - Street 1:20508 SW ROY ROGERS RD # C116
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9932
Practice Address - Country:US
Practice Address - Phone:503-906-3585
Practice Address - Fax:503-906-3586
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR26732225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist