| NPI | 1336884154 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225000000X Orthotic Fitter (Licence: NC C49754) |
| Additional Taxonomies | 224900000X Mastectomy Fitter (Licence: NC C49754) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2022-05-05 |
| Last Update Date | 2022-09-12 |