Provider Demographics
NPI:1831364702
Name:ALL ABOUT YOU WOMEN'S BOUTIQUE
Entity type:Organization
Organization Name:ALL ABOUT YOU WOMEN'S BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMMRECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-208-0467
Mailing Address - Street 1:4901 E SILVER SPRINGS BLVD
Mailing Address - Street 2:STE505
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-3219
Mailing Address - Country:US
Mailing Address - Phone:352-208-0467
Mailing Address - Fax:
Practice Address - Street 1:4901 E SILVER SPRINGS BLVD
Practice Address - Street 2:STE505
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-3219
Practice Address - Country:US
Practice Address - Phone:352-208-0467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6131470001Medicare NSC