Organization
IAMLOLAROE LTD. LIABILITY CO.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OCTAVIA MARTIN (CRANIAL PROSTHESIS SPECIALIST)
(704) 492-7186
Entity
Organization
Contact information
Practice address
6319 WATERFORD HILLS DR APT 1313, CHARLOTTE, NC 28269-1506
(704) 492-7186
Mailing address
6319 WATERFORD HILLS DR APT 1313, CHARLOTTE, NC 28269-1506
(704) 492-7186
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
05/31/2023
Last updated
05/31/2023
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