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General NPI Number Information
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NPI Number | 1447499116
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Entity Type | Organization
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Legal Business Name | THE WIG DOCTOR
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 115 GLACIER LN
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City | CEDAR HILL
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State | TX
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Zip | 75104-1364
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Country | US
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Telephone | 214-622-8328
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Fax | 972-291-8002
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Provider Business Mailing Address
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Address Line | 115 GLACIER LN
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City | CEDAR HILL
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State | TX
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Zip | 75104-1364
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Country | US
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Telephone | 214-622-8328
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Fax | 972-291-8002
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. CARLA HARVEY DEASON
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Credential |
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Telephone | 214-622-8328
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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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