Provider Demographics
NPI:1376798975
Name:SIRI'S WIG BOUTIQUE
Entity Type:Organization
Organization Name:SIRI'S WIG BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ HAIR PROSTHESIS PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIRI
Authorized Official - Middle Name:STOREVIK
Authorized Official - Last Name:CAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-865-5554
Mailing Address - Street 1:14 WHEELOCK RD
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:MA
Mailing Address - Zip Code:01590-2430
Mailing Address - Country:US
Mailing Address - Phone:508-865-5554
Mailing Address - Fax:508-865-5554
Practice Address - Street 1:344 BOSTON TPKE
Practice Address - Street 2:A
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3850
Practice Address - Country:US
Practice Address - Phone:508-799-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier