Individual
MELISSA DECKARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
530 2ND ST SW, PINE RIVER, MN 56474-4019
(601) 669-0848
Mailing address
530 2ND ST SW, PINE RIVER, MN 56474-4019
(601) 669-0848
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
OT1872
MS
174400000X
Specialist
Primary
OTT200024
LA
Other
Enumeration date
11/12/2007
Last updated
11/12/2007
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