MEDICARE: THE LOOK OF ELEGANCE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1194858787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LOOK OF ELEGANCE, INC

Provider Business Mailing Address
First Line	:	6407 SANDSHOF DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78724-4328
Country	:	US
Telephone Number	:	512-947-0775
Fax Number	:

Provider Business Practice Location Address
First Line	:	6407 SANDSHOF DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78724-4328
Country	:	US
Telephone Number	:	512-947-0775
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT OWNER
Name	:	MS. HAZEL L SCOTT
Credential	:	CERTIFIED MASTECTOMY
Telephone Number	:	512-947-0775

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	08/22/2020

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