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General NPI Number Information
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NPI Number | 1548841232
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Entity Type | Organization
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Legal Business Name | CRANIAL PROSTHESIS MEDICAL WIGS
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Dates
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Enumeration Date | 04/15/2021
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Last Update Date | 04/15/2021
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Provider Practice Location Address
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Address Line | 8763 N ORANGE AVE STE 500
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City | ORLANDO
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State | FL
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Zip | 32801-2438
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Country | US
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Telephone | 612-327-3493
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Fax |
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Provider Business Mailing Address
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Address Line | 8763 N ORANGE AVE STE 500
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City | ORLANDO
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State | FL
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Zip | 32801-2438
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Country | US
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Telephone | 612-327-3493
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KOREE WALTON
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Credential |
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Telephone | 612-327-3493
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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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