MEDICARE: CERTIFIED ORTHOTIC & PROSTHETIC, 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	LPO144	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467450726
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CERTIFIED ORTHOTIC & PROSTHETIC, INC

Provider Business Mailing Address
First Line	:	271 CLINE AVE
Second Line	:	UNIT 3
City	:	MANSFIELD
State	:	OH
Zip	:	44907-1042
Country	:	US
Telephone Number	:	419-756-6226
Fax Number	:	419-756-7737

Provider Business Practice Location Address
First Line	:	271 CLINE AVE
Second Line	:	UNIT 3
City	:	MANSFIELD
State	:	OH
Zip	:	44907-1042
Country	:	US
Telephone Number	:	419-756-6226
Fax Number	:	419-756-7737

Authorized Official
Title or Position	:	PRESIDENT/PRACTITIONER
Name	:	MR. STEVEN MARSHALL WILLIAMS
Credential	:	LPO
Telephone Number	:	419-756-6226

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	08/22/2020

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