Individual
MELISSA WOOTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
444 VIRGINIA AVE, PALMER LAKE, CO 80133
(405) 420-2973
Mailing address
PO BOX 359, PALMER LAKE, CO 80133-0359
(405) 420-2973
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
OTA.0000546
CO
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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