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General NPI Number Information
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NPI Number | 1427564020
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Entity Type | Organization
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Legal Business Name | CLARKES HAIR DESIGN
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Dates
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Enumeration Date | 12/18/2017
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Last Update Date | 03/14/2018
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Provider Practice Location Address
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Address Line | 2434 US HIGHWAY 92 E
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City | LAKELAND
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State | FL
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Zip | 33801-2650
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Country | US
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Telephone | 863-212-6008
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Fax |
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Provider Business Mailing Address
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Address Line | 4086 SUNDANCE PLACE LOOP
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City | MULBERRY
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State | FL
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Zip | 33860-0150
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Country | US
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Telephone | 863-212-6008
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JANICE MOORE
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Credential |
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Telephone | 863-212-6008
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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 | CLO210755
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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