MEDICARE: EXOTIC LENGTHS HAIR EXTENSIONS LLC

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	:	1578282596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXOTIC LENGTHS HAIR EXTENSIONS LLC

Provider Business Mailing Address
First Line	:	2866 HAVERHILL CIR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-8922
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2866 HAVERHILL CIR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420-8922
Country	:	US
Telephone Number	:	843-214-8240
Fax Number	:

Authorized Official
Title or Position	:	OWNER / LICENSED COSMETOLOGIST
Name	:	KAYLA LAWS
Credential	:
Telephone Number	:	843-214-8240

Provider Enumeration Date	:	08/23/2022
Last Update Date	:	08/23/2022

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