Provider Demographics
NPI:1679303705
Name:SAMS, MELISSA N (LMT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:N
Last Name:SAMS
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 1:2348 KIESEL AVE
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-1964
Mailing Address - Country:US
Mailing Address - Phone:801-528-5066
Mailing Address - Fax:801-528-5067
Practice Address - Street 1:2348 KIESEL AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84401-1964
Practice Address - Country:US
Practice Address - Phone:801-528-5066
Practice Address - Fax:801-528-5067
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13977786-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist