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NPI Code Detail

MEDICARE: THE513HAIRQUEEN WIGS

MEDICARE: THE513HAIRQUEEN WIGS
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
1332B00000XDurable Medical Equipment & Medical Supplies
2335E00000XProsthetic/Orthotic Supplier

General Provider Information

NPI Number : 1659147494
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE513HAIRQUEEN WIGS
Provider Business Mailing Address
First Line : 3295 GAYWAY CT
Second Line :
City : CINCINNATI
State : OH
Zip : 45239-5223
Country : US
Telephone Number : 513-371-8122
Fax Number :
Provider Business Practice Location Address
First Line : 3407 GLENMORE AVE STE A
Second Line :
City : CINCINNATI
State : OH
Zip : 45211-5451
Country : US
Telephone Number : 513-802-1705
Fax Number :
Authorized Official
Title or Position : OWNER
Name : NICOL M PRYOR
Credential :
Telephone Number : 513-371-8122
Provider Enumeration Date : 12/04/2023
Last Update Date : 12/04/2023

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Directions to “THE513HAIRQUEEN WIGS ” Practice Location

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