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1053621201
MELISSA MARIE TIETZE
BENTON, AR
NPI
1053621201
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
224Z00000X Occupational Therapy Assistant
(Licence: AR OT-A869)
Enumeration Date
2010-10-20
Last Update Date
2014-08-19
Business Address
Miss MELISSA MARIE TIETZE COTA
17706 I-30 STE 3
BENTON, AR 72019-2930
Phone number: 501-315-4414
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Mailing Address
Miss MELISSA MARIE TIETZE COTA
17706 I-30 STE 3
BENTON, AR 72019-2930
Phone number: 501-315-4414
Copy
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