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General NPI Number Information
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NPI Number | 1043855976
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Entity Type | Organization
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Legal Business Name | CHANGES STYLING SALON
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Dates
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Enumeration Date | 11/14/2019
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Last Update Date | 04/01/2020
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Provider Practice Location Address
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Address Line | 1256 W MAIN ST
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City | DILLON
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State | SC
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Zip | 29536-7926
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Country | US
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Telephone | 843-774-0170
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 646
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City | DARLINGTON
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State | SC
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Zip | 29540-0646
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHEILA BOATWRIGHT
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Credential |
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Telephone | 843-774-0170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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