Organization
THE BRACE SHOPPE INC.
Active
Other names
The Brace Shoppe, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE SUE BALL LCO (PRESIDENT/OWNER)
(304) 638-3128
Entity
Organization
Contact information
Practice address
300 WOOD MIST LN, FOUNTAIN INN, SC 29644-9273
(304) 638-3128
(304) 638-3128
Mailing address
300 WOOD MIST LN, FOUNTAIN INN, SC 29644-9273
(304) 638-3128
(304) 638-3128
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
ORT0000000095
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2609216
—
OH
05
—
3810004179
—
WV
05
—
90012089
—
KY
Enumeration date
09/13/2007
Last updated
11/15/2023
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