Birch Boutique LLC

NPI #1154045888 in Antigo, Wisconsin

Provider Information

NPI Number: 1154045888
Entity Type: Organization
Organization Name: Birch Boutique LLC
Primary Specialty: Mastectomy Fitter
Enumeration Date: Sep 27, 2022
Last Updated: Feb 29, 2024

Practice Location

Address: 612 CLEMONT ST
Address 2: STE #8
City: Antigo
State: Wisconsin
ZIP Code: 54409-1988
Phone: (715) 350-7174

Authorized Official

Name: GRETA TOMANY, RN,CMF
Title: OWNER
Phone: (715) 350-7174

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Durable Medical Equipment & Medical Supplies	332B00000X
Mastectomy Fitter	224900000X	Primary

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