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General NPI Number Information
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NPI Number | 1457605784
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Entity Type | Organization
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Legal Business Name | HAIR STOP
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Dates
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Enumeration Date | 11/08/2012
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 41 POQUONOCK AVE
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City | WINDSOR
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State | CT
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Zip | 06095-2540
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Country | US
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Telephone | 860-688-4590
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Fax |
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Provider Business Mailing Address
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Address Line | 41 POQUONOCK AVE
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City | WINDSOR
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State | CT
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Zip | 06095-2540
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Country | US
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Telephone | 860-688-4590
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. SALLY BRISTOL
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Credential |
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Telephone | 860-688-4590
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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 | 020396
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License Number State | CT
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