Organization
A MOTHER'S BOUTIQUE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUDY P MASUCCI PH.D. (OWNER)
(724) 934-8795
Entity
Organization
Contact information
Practice address
145 LAKE DR STE 102R, WEXFORD, PA 15090-8473
(724) 934-8795
(724) 965-4085
Mailing address
145 LAKE DR STE 102R, WEXFORD, PA 15090-8473
(724) 934-8795
(724) 965-4085
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
84060346
PA
Other
Enumeration date
02/22/2012
Last updated
02/22/2012
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