Healthcare Provider Details

I. General information

NPI: 1023569803
Provider Name (Legal Business Name): B&B'S HEALTH BOUTIQUE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 11/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 COURT ST
WETUMPKA AL
36092-2709
US

IV. Provider business mailing address

102 COURT ST
WETUMPKA AL
36092-2709
US

V. Phone/Fax

Practice location:
  • Phone: 334-478-5090
  • Fax: 844-826-8064
Mailing address:
  • Phone: 334-478-5090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: BONNIE ELIZABETH BELL
Title or Position: OWNER
Credential:
Phone: 540-313-4705