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General NPI Number Information
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NPI Number | 1497659296
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Entity Type | Organization
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Legal Business Name | OCEANS OF HOPE BREAST CARE BOUTIQUE LLC
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 426 WESTERN AVE
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City | STATESVILLE
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State | NC
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Zip | 28677-5730
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Country | US
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Telephone | 732-266-8065
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5392
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City | STATESVILLE
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State | NC
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Zip | 28687-5392
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Country | US
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Telephone | 732-266-8065
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Fax | 704-270-9200
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Authorized Official
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Title or Position | OWNER
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Name | KAREN DONOHUE
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Credential | CFM
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Telephone | 732-266-8065
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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 | NULL
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