=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164551479
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAIR2WEAR, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11624 WILLOW WAY
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73162-2046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-823-0130
-----------------------------------------------------
Fax | 405-720-1231
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11624 WILLOW WAY
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73162-2046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-823-0130
-----------------------------------------------------
Fax | 405-720-1231
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. TOMEKA DIANNE WALKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 866-823-0130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------