Provider Demographics
NPI:1487868220
Name:KENNEDYS MASTECTOMY PRODUCTS WIGS & TURBANS LLC
Entity Type:Organization
Organization Name:KENNEDYS MASTECTOMY PRODUCTS WIGS & TURBANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A L
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-817-8354
Mailing Address - Street 1:19 WEEKS LANE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2500
Mailing Address - Country:US
Mailing Address - Phone:603-817-8354
Mailing Address - Fax:603-742-3053
Practice Address - Street 1:19 WEEKS LANE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2500
Practice Address - Country:US
Practice Address - Phone:603-817-8354
Practice Address - Fax:603-742-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Multi-Specialty
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier