=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851705321
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WIGFUL THINKING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2014
-----------------------------------------------------
Last Update Date | 06/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1905 ROUTE 33 SUITE 3
-----------------------------------------------------
City | HAMILTON SQUARE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08690-1742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-249-4811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1905 ROUTE 33 SUITE 3
-----------------------------------------------------
City | HAMILTON SQUARE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08690-1742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-249-4811
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROPRIETOR
-----------------------------------------------------
Name | CARYL DILLON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 609-249-4811
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | 1815809
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------