Provider Demographics
NPI:1497905921
Name:WIGGODDESS.COM
Entity Type:Organization
Organization Name:WIGGODDESS.COM
Other - Org Name:GREAT LENGTHS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER - SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CLARE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCAFEE
Authorized Official - Suffix:
Authorized Official - Credentials:BUSINESS OWNER
Authorized Official - Phone:8022-291-1112
Mailing Address - Street 1:89 KARL CIR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-9526
Mailing Address - Country:US
Mailing Address - Phone:802-229-1112
Mailing Address - Fax:
Practice Address - Street 1:89 KARL CIR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-9526
Practice Address - Country:US
Practice Address - Phone:802-229-1112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-20
Last Update Date:2008-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier