Organization
WELLDOM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS KEISHA MICHELLE LEWIS OTR/L (OWNER)
(704) 387-6420
Entity
Organization
Contact information
Practice address
112 LAKENHEATH LN # A, MATTHEWS, NC 28105-6501
(803) 840-3312
Mailing address
5009 BEATTIES FORD RD STE 107-220, CHARLOTTE, NC 28216-2859
(704) 387-6420
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
09/25/2023
Last updated
09/25/2023
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