Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CO072859 | GA |
NPI | 1376869263 |
---|---|
Provider Name | Mrs. Lyvetta Walker Marshall |
First Address | Martinez, GA 30907-9578 |
Second Address | Martinez, GA 30907-8405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2010 |
Last Update Date | 16/04/2010 |