MEDICARE: WIGGLESTONE ENTERPRISES LLC DBA KELTIC BELLE

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	:	1821805649
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WIGGLESTONE ENTERPRISES LLC DBA KELTIC BELLE

Provider Business Mailing Address
First Line	:	220 W MAIN ST
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27520-2323
Country	:	US
Telephone Number	:	919-867-7007
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 W MAIN ST
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27520-2323
Country	:	US
Telephone Number	:	919-867-7007
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL OWNER
Name	:	CINDY ANN PURSELL
Credential	:
Telephone Number	:	919-867-7007

Provider Enumeration Date	:	12/16/2024
Last Update Date	:	05/13/2026

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