MEDICARE: THE LICE REMOVAL RESOURCE CENTER

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	174400000X	Specialist		TX

General Provider Information

NPI Number	:	1346545191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE LICE REMOVAL RESOURCE CENTER

Provider Business Mailing Address
First Line	:	921 W GARDNER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-5017
Country	:	US
Telephone Number	:	713-899-9777
Fax Number	:

Provider Business Practice Location Address
First Line	:	921 W GARDNER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77009-5017
Country	:	US
Telephone Number	:	713-899-9777
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. KIMBERLY JOZWIAK
Credential	:
Telephone Number	:	713-899-9777

Provider Enumeration Date	:	01/25/2011
Last Update Date	:	01/25/2011

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Directions to “THE LICE REMOVAL RESOURCE CENTER ” Practice Location

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