Provider Demographics
NPI:1083239891
Name:K.N. MEDICAL WIGS INC
Entity Type:Organization
Organization Name:K.N. MEDICAL WIGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALANDRAE
Authorized Official - Middle Name:
Authorized Official - Last Name:KISLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-837-9093
Mailing Address - Street 1:651 E MAIN ST STE I
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-4240
Mailing Address - Country:US
Mailing Address - Phone:863-837-9093
Mailing Address - Fax:863-588-4176
Practice Address - Street 1:651 E MAIN ST STE I
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-4240
Practice Address - Country:US
Practice Address - Phone:863-837-9093
Practice Address - Fax:863-588-4176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-08
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier