Provider Demographics
NPI:1700530995
Name:I SPY HER WIGS
Entity Type:Organization
Organization Name:I SPY HER WIGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:JALISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SPY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-510-1398
Mailing Address - Street 1:397 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1409
Mailing Address - Country:US
Mailing Address - Phone:330-510-1398
Mailing Address - Fax:330-583-8861
Practice Address - Street 1:397 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1409
Practice Address - Country:US
Practice Address - Phone:330-510-1398
Practice Address - Fax:330-583-8861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier