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General NPI Number Information
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NPI Number | 1497355689
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Entity Type | Organization
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Legal Business Name | HAIR ON THE EDGE
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 9708 LACKLAND RD
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City | OVERLAND
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State | MO
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Zip | 63114-3414
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Country | US
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Telephone | 314-281-0081
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Fax |
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Provider Business Mailing Address
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Address Line | 9708 LACKLAND RD
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City | OVERLAND
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State | MO
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Zip | 63114-3414
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Country | US
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Telephone | 314-281-0081
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Fax |
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Authorized Official
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Title or Position | CERTIFIED HAIR LOSS SPECIALIST
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Name | HELEN BANKS
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Credential |
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Telephone | 314-281-0081
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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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