Organization
WELLNESS SOURCE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. HEATHER SWANSON LITTLE (PRESIDENT)
(704) 799-2873
Entity
Organization
Contact information
Practice address
125 COMMERCE PARK RD, SUITE 105, MOORESVILLE, NC 28117-7131
(704) 799-2873
Mailing address
PO BOX 4837, MOORESVILLE, NC 28117-4837
Taxonomy
Speciality
Code
Description
License number
State
224900000X
Mastectomy Fitter
—
—
225000000X
Orthotic Fitter
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
01026
NC
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
—
—
332BD1200X
Dialysis Equipment & Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7704485
—
NC
Enumeration date
09/15/2006
Last updated
09/12/2022
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