Provider Demographics
NPI:1689282865
Name:THOMAS, MARQUETTA L (CRT HAIR REPLACEMENT)
Entity Type:Individual
Prefix:
First Name:MARQUETTA
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CRT HAIR REPLACEMENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 HILLIARD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-2689
Mailing Address - Country:US
Mailing Address - Phone:910-978-3276
Mailing Address - Fax:
Practice Address - Street 1:2203 SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-2257
Practice Address - Country:US
Practice Address - Phone:910-978-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist