Recreate Mastectomy Products & Boutique

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

RECREATE MASTECTOMY PRODUCTS & BOUTIQUE

Practice address

116 South Ave W
Missoula, MT 59801-8116

Phone

(406) 721-4242

NPI assigned

Sep 4, 2008

Organization subpart

Yes

Parent organization

MISSOULA ORTHOTICS & PROSTHETICS LABORATORY, INC.As reported in NPPES

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

Authorized official

Name

Mrs. Karen J Williams, R.N.

Title

Treasurer

Phone

(406) 549-0921

Specialties & licenses 1

Addresses

Other names 1

• ReCreate Mastectomy Products & Boutique Doing business as

Part of

Missoula Orthotics Prosthetics Laboratory Inc

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

{
    "created_epoch": "1220486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248393600000",
    "number": "1740438696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 SOUTH AVE W",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598018116",
            "telephone_number": "406-721-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 SOUTH AVE W",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598018116",
            "telephone_number": "406-721-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RECREATE MASTECTOMY PRODUCTS & BOUTIQUE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MISSOULA ORTHOTICS & PROSTHETICS LABORATORY, INC.",
        "enumeration_date": "2008-09-04",
        "last_updated": "2009-07-24",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "406-549-0921",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ReCreate Mastectomy Products & Boutique",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Prosthetic/Orthotic Supplier in Missoula, MT
• Providers in Missoula, MT by specialty
• Prosthetic/Orthotic Supplier in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2009; 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.