=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043747231
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANDS OF TRANSFORMATION HAIR LOSS CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11980 WESTHEIMER RD STE G
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77077-6670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-868-3657
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11980 WESTHEIMER RD STE G
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77077-6670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-868-3657
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/SPECIALIST
-----------------------------------------------------
Name | DARNESHIA FORD
-----------------------------------------------------
Credential | CHLS
-----------------------------------------------------
Telephone | 832-868-3657
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------