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General NPI Number Information
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NPI Number | 1982141115
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Entity Type | Organization
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Legal Business Name | DEBRAS HAIR STUDIO LLC
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 1516 BYPASS 72 NE STE D
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City | GREENWOOD
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State | SC
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Zip | 29649
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Country | US
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Telephone | 864-993-4545
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Fax |
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Provider Business Mailing Address
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Address Line | 1516 BYPASS 72 NE STE D
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City | GREENWOOD
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State | SC
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Zip | 29649-2268
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Country | US
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Telephone | 864-993-4545
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEBRA WRIGHT MOTON
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Credential |
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Telephone | 864-993-4545
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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 | SC
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