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General NPI Number Information
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NPI Number | 1659664407
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Entity Type | Organization
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Legal Business Name | HEAVEN ON EARTH SALON LLC
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 1612 W SYLVANIA AVE
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City | TOLEDO
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State | OH
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Zip | 43612-1589
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Country | US
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Telephone | 419-917-1268
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Fax |
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Provider Business Mailing Address
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Address Line | 1612 W SYLVANIA AVE
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City | TOLEDO
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State | OH
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Zip | 43612-1589
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Country | US
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Telephone | 419-917-1268
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Fax |
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Authorized Official
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Title or Position | PROSTHETIC SPECIALIST /COSM.
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Name | MRS. VERONICA L FLETCHER
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Credential | SPECIALIST
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Telephone | 419-917-1268
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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 | 953162
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License Number State | OH
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