Organization
TLG INC
Active
Other names
Cocos Boutique & Specialty Shoppe
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. THERESA HESTER JOHNSON CERTIFIED FITTER (COMPANY PRESIDENT OWNER FITTER)
(219) 836-0011
Entity
Organization
Contact information
Practice address
921 RIDGE RD, C2, MUNSTER, IN 46321-1739
(219) 836-0011
(219) 836-0140
Mailing address
921 RIDGE RD, C2, MUNSTER, IN 46321-1739
(219) 836-0011
(219) 836-0140
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
09/30/2005
Last updated
08/22/2020
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