Provider Demographics
NPI:1356312250
Name:UNIQUE BOUTIQUE INC
Entity Type:Organization
Organization Name:UNIQUE BOUTIQUE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KUCHARSKI-NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-377-4356
Mailing Address - Street 1:2021 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204
Mailing Address - Country:US
Mailing Address - Phone:704-377-4356
Mailing Address - Fax:704-377-9361
Practice Address - Street 1:2021 E 7TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3335
Practice Address - Country:US
Practice Address - Phone:704-377-4356
Practice Address - Fax:704-377-9361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0193430001OtherDME
NC0193430001Medicare ID - Type Unspecified