Provider Demographics
NPI:1093045619
Name:TOUCH OF ELEGANCE BOUTIQUE LLC
Entity Type:Organization
Organization Name:TOUCH OF ELEGANCE BOUTIQUE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-776-0005
Mailing Address - Street 1:3426 BRAMBLETON AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6534
Mailing Address - Country:US
Mailing Address - Phone:540-776-0005
Mailing Address - Fax:
Practice Address - Street 1:3426 BRAMBLETON AVE
Practice Address - Street 2:STE 4
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6534
Practice Address - Country:US
Practice Address - Phone:540-776-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA100030224335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier