Healthcare Provider Details

I. General information

NPI: 1275325144
Provider Name (Legal Business Name): HALO MEDICAL WIGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 SHADOW POINTE RD
THIBODAUX LA
70301-8448
US

IV. Provider business mailing address

10202 PERKINS ROWE STE E
BATON ROUGE LA
70810-2067
US

V. Phone/Fax

Practice location:
  • Phone: 985-688-8264
  • Fax:
Mailing address:
  • Phone: 985-688-8264
  • 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: JAMESHEA HARRIS
Title or Position: OWNER
Credential:
Phone: 985-688-8264