Individual
MARKEISHA LAQUITA WARDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1502 TINY TOWN RD, CLARKSVILLE, TN 37042-8087
(931) 645-4270
Mailing address
3684 AURORA DR, CLARKSVILLE, TN 37040-2553
(931) 591-8501
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
0107051558
TN
Other
Enumeration date
07/13/2020
Last updated
07/13/2020
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