MEDICARE: SECOND SILHOUETTE, 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	:	1740358191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECOND SILHOUETTE, INC

Provider Business Mailing Address
First Line	:	17000 EL CAMINO REAL
Second Line	:	SUITE 106
City	:	HOUSTON
State	:	TX
Zip	:	77058-2636
Country	:	US
Telephone Number	:	281-286-1943
Fax Number	:	281-286-4340

Provider Business Practice Location Address
First Line	:	17000 EL CAMINO REAL
Second Line	:	SUITE 106
City	:	HOUSTON
State	:	TX
Zip	:	77058-2636
Country	:	US
Telephone Number	:	281-286-1943
Fax Number	:	281-286-4340

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	PAMELA J PETAK
Credential	:
Telephone Number	:	713-529-3733

Provider Enumeration Date	:	12/02/2006
Last Update Date	:	11/01/2007

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Directions to “SECOND SILHOUETTE, INC ” Practice Location

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