| NPI | 1992350318 |
|---|---|
| Doing Business As | TRACEY'S BOUTIQUE |
| Entity Type | Organization |
| Authorized Contact | TRACEY L FOGLE Owner 719-424-7565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 224900000X Mastectomy Fitter |
| Enumeration Date | 2019-08-02 |
| Last Update Date | 2022-11-16 |