# IMAGE MAKER HAIR SALON AND WIG STUDIO

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619536760
- **Authorized official:** ALICE MOHLER (OWNER)
- **Authorized official phone:** (434) 385-0347

## Contact information

- **Practice address:** 1033A CLAYMONT DR, LYNCHBURG, VA 24502-4481
- **Practice address phone:** (434) 385-0347
- **Mailing address:** 1033A CLAYMONT DR, LYNCHBURG, VA 24502-4481
- **Mailing address phone:** (434) 385-0347

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 224P00000X | Prosthetist | — | — | Yes |

## Other

- **Enumeration date:** 06/12/2019
- **Last updated:** 06/12/2019