Organization
JELISSA NICOLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JELISSA BATES (OWNER)
(214) 497-8580
Entity
Organization
Contact information
Practice address
18880 MARSH LN APT 1902, DALLAS, TX 75287-2241
(214) 497-8580
Mailing address
18880 MARSH LN APT 1902, DALLAS, TX 75287-2241
(214) 497-8580
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
01/21/2021
Last updated
01/21/2021
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