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General NPI Number Information
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NPI Number | 1083239891
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Entity Type | Organization
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Legal Business Name | K.N. MEDICAL WIGS INC
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 06/24/2020
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Provider Practice Location Address
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Address Line | 651 E MAIN ST STE I
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City | HAINES CITY
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State | FL
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Zip | 33844-4240
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Country | US
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Telephone | 863-837-9093
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Fax | 863-588-4176
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Provider Business Mailing Address
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Address Line | 651 E MAIN ST STE I
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City | HAINES CITY
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State | FL
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Zip | 33844-4240
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Country | US
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Telephone | 863-837-9093
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Fax | 863-588-4176
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Authorized Official
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Title or Position | OWNER
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Name | SALANDRAE KISLER
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Credential |
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Telephone | 863-837-9093
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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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