Provider Demographics
NPI:1053610873
Name:DEMARAIS, MELISSA ANNE (LMT, NMT)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANNE
Last Name:DEMARAIS
Suffix:
Gender:F
Credentials:LMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 PHILLIPS ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-4146
Mailing Address - Country:US
Mailing Address - Phone:406-490-3190
Mailing Address - Fax:406-494-2045
Practice Address - Street 1:1554 HARRISON AVENUE SUITE E
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-4806
Practice Address - Country:US
Practice Address - Phone:406-490-3190
Practice Address - Fax:406-299-3288
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT550225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist