Individual
MARTY WADE GROOMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR L
Contact information
Practice address
24 PHYSICIANS DR, JACKSON, TN 38305-2070
(731) 410-2357
(731) 410-2304
Mailing address
1122 CRAZY DOE RD, LEXINGTON, TN 38351-4718
(731) 693-5571
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
02904
TN
Other
Enumeration date
10/23/2006
Last updated
10/13/2011
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