Provider Demographics
NPI:1609404250
Name:MCMASTER, MELISSA LYNNE (LMT CCP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNNE
Last Name:MCMASTER
Suffix:
Gender:F
Credentials:LMT CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 GLENWOOD ST STE 101E
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1300
Mailing Address - Country:US
Mailing Address - Phone:816-761-3847
Mailing Address - Fax:
Practice Address - Street 1:9200 GLENWOOD ST STE 101E
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1300
Practice Address - Country:US
Practice Address - Phone:816-761-3847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005034943225700000X
KSTHR-060707225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist