Organization
THE LONDON KNOT WIG BOUTIQUE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIERRA LASHAE ROYSTER (ADMIN DIRECTOR)
(301) 792-4607
Entity
Organization
Contact information
Practice address
6957 AQUAMARINE CT, CAPITOL HEIGHTS, MD 20743-1879
(301) 792-4607
Mailing address
6957 AQUAMARINE CT, CAPITOL HEIGHTS, MD 20743-1879
(301) 792-4607
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
03/28/2021
Last updated
03/28/2021
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