Doctor Name: | MS. MELISSA ANN KOONCE |
NPI Number: | 1588778914 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, ATC |
License Number: | |
Business Practice Address: | 12277 De Paul Dr Ste 305 Bridgeton, MO - 630442529 |
Business Phone Number: | 3142913399 |
Business Fax Number: | 3142913466 |
Mailing Address: | 505 Louisa Ave, DUPO |
State: | IL |
Postal Code: | 622391407 |
Phone Number: | 6182864154 |
Fax Number: | |
NPI Enumeration Date: | 08/19/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |