The Forms Boutique, Inc.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

THE FORMS BOUTIQUE, INC.

Practice address

3308 Forest Dr
Columbia, SC 29204-4024

Phone

(803) 738-8400

Fax

(803) 738-8498

NPI assigned

Oct 3, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Amy D. McLellan, RFM, CMF

Title

President

Phone

(803) 799-7096

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584403200000",
    "number": "1689768376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3308 FOREST DR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292044024",
            "telephone_number": "803-738-8400",
            "fax_number": "803-738-8498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3308 FOREST DR",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292044024",
            "telephone_number": "803-738-8400",
            "fax_number": "803-738-8498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE FORMS BOUTIQUE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-03-17",
        "certification_date": "2020-03-17",
        "status": "A",
        "authorized_official_last_name": "MCLELLAN",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-799-7096",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RFM, CMF"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "556570",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Columbia, SC
• Providers in Columbia, SC by specialty
• Prosthetic/Orthotic Supplier in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.