Individual
AUTUM MARIE MALLICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7165 TEE DON CT, HOLT, FL 32564-8925
(850) 313-9846
Mailing address
7165 TEE DON CT, HOLT, FL 32564-8925
(850) 313-9846
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
—
—
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
11/13/2019
Last updated
11/14/2019
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