Individual
MARY BETH WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1471 BOAT DOCK RD, SOMERSET, KY 42501-9246
(606) 492-7620
Mailing address
1471 BOAT DOCK RD, SOMERSET, KY 42501-9246
(606) 492-7620
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
12/02/2020
Last updated
12/02/2020
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