Provider Demographics
NPI:1053557397
Name:HAMM, MELODY J (MFR, NMT,,MYO, DOULA)
Entity type:Individual
Prefix:MRS
First Name:MELODY
Middle Name:J
Last Name:HAMM
Suffix:
Gender:F
Credentials:MFR, NMT,,MYO, DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2208
Mailing Address - Country:US
Mailing Address - Phone:941-928-5116
Mailing Address - Fax:
Practice Address - Street 1:1213 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2208
Practice Address - Country:US
Practice Address - Phone:941-928-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33686225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist