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General NPI Number Information
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NPI Number | 1295694958
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Entity Type | Organization
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Legal Business Name | MEDICAL WIG BOUTIQUE, LLC
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Dates
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Enumeration Date | 01/19/2026
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Last Update Date | 01/19/2026
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Provider Practice Location Address
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Address Line | 12514 MILL CT
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City | HOUSTON
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State | TX
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Zip | 77070-4912
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Country | US
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Telephone | 713-715-9448
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Fax | 713-715-9448
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Provider Business Mailing Address
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Address Line | 12514 MILL CT
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City | HOUSTON
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State | TX
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Zip | 77070
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Country | US
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Telephone |
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Fax | 713-715-9448
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Authorized Official
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Title or Position | CRANIAL PROTHESIS SPECIALIST
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Name | ASHLEY HALL
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Credential |
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Telephone | 713-715-9448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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