=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548051196
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOREIGNTOUCH BY DOLLY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2025
-----------------------------------------------------
Last Update Date | 05/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 460 E 35TH ST STE 17
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60616-4144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-807-0942
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9228 S EGGLESTON AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60620-2309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-807-0942
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MORGAN EZELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-807-0942
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------