Provider Demographics
NPI:1174827398
Name:WIGGEN, KELLY ROBERTS (COF)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ROBERTS
Last Name:WIGGEN
Suffix:
Gender:F
Credentials:COF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 EAST WALKER STREET
Mailing Address - Street 2:
Mailing Address - City:EAST FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28726
Mailing Address - Country:US
Mailing Address - Phone:828-595-9371
Mailing Address - Fax:828-595-9373
Practice Address - Street 1:107 EAST WALKER STREET
Practice Address - Street 2:
Practice Address - City:EAST FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28726
Practice Address - Country:US
Practice Address - Phone:828-595-9371
Practice Address - Fax:828-595-9373
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter