Basic Information
| Provider Information | |||||||||
| NPI: | 1982249439 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHARRON | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | KAYE | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15927 52ND ST E APT C | ||||||||
| Address2: | |||||||||
| City: | SUMNER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983903151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2533651846 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10004 204TH AVE E STE 3100 | ||||||||
| Address2: | |||||||||
| City: | BONNEY LAKE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983916540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538637510 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2019 | ||||||||
| LastUpdateDate: | 11/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.