MEDICARE: CRANIAL TECHNOLOGIES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1043071368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRANIAL TECHNOLOGIES, INC.

Provider Business Mailing Address
First Line	:	1405 W AUTO DR FL 2
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284-1227
Country	:	US
Telephone Number	:	844-447-5894
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 NW 6TH ST STE 105
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-1219
Country	:	US
Telephone Number	:	844-447-5894
Fax Number	:

Authorized Official
Title or Position	:	COMPLIANCE & MEDICAID SPECIALIST
Name	:	OUMOU K BAH
Credential	:
Telephone Number	:	602-393-8188

Provider Enumeration Date	:	01/23/2024
Last Update Date	:	01/23/2024

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