Provider Demographics
NPI:1861629446
Name:WIGGINS, KENT JOSEPH (CPO)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:JOSEPH
Last Name:WIGGINS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 MOSSY OAKS RD
Mailing Address - Street 2:
Mailing Address - City:PORT ROYAL
Mailing Address - State:SC
Mailing Address - Zip Code:29935-1046
Mailing Address - Country:US
Mailing Address - Phone:843-379-9047
Mailing Address - Fax:843-379-9048
Practice Address - Street 1:2210 MOSSY OAKS RD
Practice Address - Street 2:
Practice Address - City:PORT ROYAL
Practice Address - State:SC
Practice Address - Zip Code:29935-1046
Practice Address - Country:US
Practice Address - Phone:843-379-9047
Practice Address - Fax:843-379-9048
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist