Provider Demographics
NPI:1831128776
Name:THE TOTAL WOMAN BOUTIQUE, INC.
Entity Type:Organization
Organization Name:THE TOTAL WOMAN BOUTIQUE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:R
Authorized Official - Last Name:ADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:225-924-4531
Mailing Address - Street 1:9244 FLORIDA BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-1160
Mailing Address - Country:US
Mailing Address - Phone:225-924-4531
Mailing Address - Fax:225-927-6986
Practice Address - Street 1:9244 FLORIDA BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-1160
Practice Address - Country:US
Practice Address - Phone:225-924-4531
Practice Address - Fax:225-927-6986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA503248700011744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1327760Medicaid
LA0238880001Medicare NSC