| Organization Name: | FABULOUS WEAVE , LLC |
| NPI Number: | 1083960801 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANDREA DOCTOR (RNCONSULT FOR CRANIAL PROSTHESIS) |
| Mailing Address: | 10595 Sourwood Ave Waldorf |
| State: | MD US |
| Postal Code: | 206035730 |
| Phone Number: | 3016458765 |
| Fax Number: | 3016459611 |
| NPI Enumeration Date: | 07/30/2012 |
| NPI Last Update Date: | 07/30/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |