NPI 1154045888

Birch Boutique LLC

Organisation Mastectomy Fitter Antigo, WI

Practice location

Address: 612 Clemont St STE #8, Antigo, WI 54409-1988
Phone: (715) 350-7174
Fax: (715) 716-4330

Authorised official

Name: Greta Tomany
Title: Owner
Phone: (715) 350-7174

Registered specialties (2)

Mastectomy Fitter Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 224900000X

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Durable Medical Equipment & Medical Supplies

Suppliers Taxonomy 332B00000X

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Registry record

NPI: 1154045888
Entity type: Organization
NPI issued: 27 Sep 2022
Record last updated: 29 Feb 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.