Provider Demographics
NPI:1356559348
Name:WELTON, WADE M (ATC)
Entity type:Individual
Prefix:MR
First Name:WADE
Middle Name:M
Last Name:WELTON
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
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Mailing Address - Street 1:521 COUNTY ROAD 105
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MO
Mailing Address - Zip Code:65248-8833
Mailing Address - Country:US
Mailing Address - Phone:660-248-6217
Mailing Address - Fax:660-248-6381
Practice Address - Street 1:411 CENTRAL METHODIST SQ
Practice Address - Street 2:CENTRAL METHODIST UNIVERSITY
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248-1104
Practice Address - Country:US
Practice Address - Phone:660-248-6217
Practice Address - Fax:660-248-6381
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO1024372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer