Organization
THE WIG REVIVER
Active
Other names
The Wig Reviver
Organization subpart
No
Provider details
NPI number
Authorized official
MONICA ELLIOTT PROSTHETICSPECIALIST (OWNER)
(980) 616-0374
Entity
Organization
Contact information
Practice address
503 36TH ST SE APT C, LARGO, FL 33771-2716
(980) 616-0374
Mailing address
503 36TH ST SE APT C, LARGO, FL 33771-2716
(980) 616-0374
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
11/25/2022
Last updated
11/30/2022
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