Provider Demographics
NPI:1083230502
Name:AMAZING WIG CLOSET
Entity Type:Organization
Organization Name:AMAZING WIG CLOSET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-843-9992
Mailing Address - Street 1:409 W FRONT ST STE 100-306
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-4204
Mailing Address - Country:US
Mailing Address - Phone:512-843-9992
Mailing Address - Fax:844-205-9447
Practice Address - Street 1:409 W FRONT ST STE 100-306
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-4204
Practice Address - Country:US
Practice Address - Phone:512-843-9992
Practice Address - Fax:844-205-9447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-20
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier