Organization
MITZI NIKKOLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MITZI MORRIS (OWNER)
(270) 627-1247
Entity
Organization
Contact information
Practice address
509 ELM ST, MARTIN, TN 38237-3407
(270) 627-1247
Mailing address
PO BOX 13, HICKMAN, KY 42050-0013
(270) 627-1247
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
06/03/2021
Last updated
06/03/2021
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