Individual
ELI SAMUEL NOLASCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
80 MADDEX DR, SHEPHERDSTOWN, WV 25443-4305
(304) 876-9422
Mailing address
127 AVERRELL AVE, WINCHESTER, VA 22603-5822
(540) 409-7139
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
C2395
WV
Other
Enumeration date
10/11/2021
Last updated
10/11/2021
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