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General NPI Number Information
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NPI Number | 1124356993
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Entity Type | Organization
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Legal Business Name | NATURAL TRESSES LLC
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Dates
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Enumeration Date | 12/05/2009
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Last Update Date | 12/05/2009
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Provider Practice Location Address
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Address Line | 2011 N RICHMOND ST
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City | APPLETON
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State | WI
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Zip | 54911-2771
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Country | US
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Telephone | 920-268-5267
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Fax | 920-358-5419
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Provider Business Mailing Address
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Address Line | PO BOX 603
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City | APPLETON
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State | WI
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Zip | 54912-0603
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Country | US
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Telephone | 920-268-5267
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Fax | 920-358-5419
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Authorized Official
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Title or Position | OWNER
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Name | MR. MONTREAL C. GLOSSON
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Credential |
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Telephone | 920-257-6806
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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 | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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