MEDICARE: THE WIG FACTORY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1417522277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WIG FACTORY

Provider Business Mailing Address
First Line	:	642 W CHURCH ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32805-2269
Country	:	US
Telephone Number	:
Fax Number	:	407-650-3182

Provider Business Practice Location Address
First Line	:	642 W CHURCH ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32805-2269
Country	:	US
Telephone Number	:	407-613-6031
Fax Number	:

Authorized Official
Title or Position	:	MGR
Name	:	MS. QUTERIA TEAGUE
Credential	:
Telephone Number	:	407-613-6031

Provider Enumeration Date	:	05/24/2021
Last Update Date	:	06/04/2026

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Directions to “THE WIG FACTORY ” Practice Location

Language	Start Address	Practice Location

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