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General NPI Number Information
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NPI Number | 1851451231
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Entity Type | Organization
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Legal Business Name | MARY LOU MARQUES PRO STYLIST
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 12/19/2007
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Provider Practice Location Address
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Address Line | 33 CLUB AVENUE ACUSHNET MASS 02743 1980 ACUSHNET AVENUE
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City | NEW BEDFORD
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State | MA
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Zip | 02745
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Country | US
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Telephone | 508-995-7855
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Fax | 508-995-7161
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Provider Business Mailing Address
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Address Line | 33 CLUB AVENUE ACUSHNET MASS 02743 1980 ACUSHNET AVENUE
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City | NEW BEDFORD
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State | MA
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Zip | 02745
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Country | US
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Telephone | 508-995-7855
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Fax | 508-995-7161
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARY LOU MARQUES
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Credential | LICENSED HAIR STYLIS
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Telephone | 508-995-2855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 4003564
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 4003564
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License Number State | MA
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