| Doctor Name: | MRS. KELLY ROBERTS WIGGEN |
| NPI Number: | 1174827398 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | COF |
| License Number: | |
| Business Practice Address: | 107 East Walker Street East Flat Rock, NC - 28726 |
| Business Phone Number: | 8285959371 |
| Business Fax Number: | 8285959373 |
| Mailing Address: | 107 East Walker Street, EAST FLAT ROCK |
| State: | NC |
| Postal Code: | 28726 |
| Phone Number: | 8285959371 |
| Fax Number: | 8285959373 |
| NPI Enumeration Date: | 01/03/2011 |
| NPI Last Update Date: | 03/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225000000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Orthotic Fitter |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual trained in the management of fitting prefabricated orthoses. |