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General NPI Number Information
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NPI Number | 1063225902
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Entity Type | Organization
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Legal Business Name | THE WIG COLLECTIVE
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 07/11/2025
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Provider Practice Location Address
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Address Line | 3400 W MAYFLOWER WAY STE 124
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City | LEHI
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State | UT
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Zip | 84048-3256
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Country | US
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Telephone | 801-899-9765
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Fax |
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Provider Business Mailing Address
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Address Line | 80 S 1300 E
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-3024
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Country | US
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Telephone | 707-761-3354
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTEN SCHOW
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Credential | CPS
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Telephone | 801-899-9765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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