Provider Demographics
NPI:1477914554
Name:SALES, TAKESHA L (CERT HAIR LOSS SPECI)
Entity Type:Individual
Prefix:
First Name:TAKESHA
Middle Name:L
Last Name:SALES
Suffix:
Gender:F
Credentials:CERT HAIR LOSS SPECI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 LAURENS RD
Mailing Address - Street 2:SUITE #109
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2961
Mailing Address - Country:US
Mailing Address - Phone:864-283-6804
Mailing Address - Fax:864-283-6805
Practice Address - Street 1:1607 LAURENS RD
Practice Address - Street 2:SUITE #109
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2961
Practice Address - Country:US
Practice Address - Phone:864-283-6804
Practice Address - Fax:864-283-6805
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management