Individual
MR. RANDY HAROLD TACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1821 N 150 W, WABASH, IN 46992-8728
(260) 563-0142
(260) 563-6565
Mailing address
1821 N 150 W, WABASH, IN 46992-8728
(260) 563-0142
(260) 563-6565
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
—
—
Other
Enumeration date
03/06/2007
Last updated
07/08/2007
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