Provider Demographics
NPI:1912507369
Name:MOTTON, MARQUARITE
Entity type:Individual
Prefix:
First Name:MARQUARITE
Middle Name:
Last Name:MOTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 PRINCESS ANNE ST # A
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3255
Mailing Address - Country:US
Mailing Address - Phone:540-538-7686
Mailing Address - Fax:
Practice Address - Street 1:2621 PRINCESS ANNE ST # A
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3255
Practice Address - Country:US
Practice Address - Phone:540-899-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2746526161744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management