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General NPI Number Information
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NPI Number | 1376798975
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Entity Type | Organization
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Legal Business Name | SIRI'S WIG BOUTIQUE
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 344 BOSTON TPKE A
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City | SHREWSBURY
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State | MA
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Zip | 01545-3850
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Country | US
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Telephone | 508-799-2500
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Fax |
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Provider Business Mailing Address
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Address Line | 14 WHEELOCK RD
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City | SUTTON
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State | MA
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Zip | 01590-2430
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Country | US
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Telephone | 508-865-5554
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Fax | 508-865-5554
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Authorized Official
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Title or Position | OWNER/ HAIR PROSTHESIS PROVIDER
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Name | MRS. SIRI STOREVIK CAYA
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Credential |
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Telephone | 508-865-5554
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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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