Individual
MRS. OPHELIA RENEE WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMA
Contact information
Practice address
6568 EMMITT ST, MILLINGTON, TN 38053-8267
(901) 873-3081
Mailing address
6568 EMMITT ST, MILLINGTON, TN 38053-8267
(901) 873-3081
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
TN
Other
Enumeration date
06/01/2012
Last updated
06/01/2012
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