Healthcare Provider Details

I. General information

NPI: 1831128776
Provider Name (Legal Business Name): THE TOTAL WOMAN BOUTIQUE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9244 FLORIDA BLVD SUITE C
BATON ROUGE LA
70815-1160
US

IV. Provider business mailing address

9244 FLORIDA BLVD SUITE C
BATON ROUGE LA
70815-1160
US

V. Phone/Fax

Practice location:
  • Phone: 225-924-4531
  • Fax: 225-927-6986
Mailing address:
  • Phone: 225-924-4531
  • Fax: 225-927-6986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number50324870001
License Number StateLA

VIII. Authorized Official

Name: MS. RUTH R ADDISON
Title or Position: OWNER
Credential: CMF
Phone: 225-924-4531