MEDICARE: OWENS CAROLINA ORTHOTIC & PROSTHETIC NETWORK, 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
2	332BC3200X	Customized Equipment (DME)

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	:	1881643807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OWENS CAROLINA ORTHOTIC & PROSTHETIC NETWORK, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1268
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29716-1268
Country	:	US
Telephone Number	:	704-332-5143
Fax Number	:	866-670-5370

Provider Business Practice Location Address
First Line	:	3535 RANDOLPH RD STE 210
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-5027
Country	:	US
Telephone Number	:	704-332-5143
Fax Number	:	866-670-5370

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	SUSAN WALLACE
Credential	:	MHCA
Telephone Number	:	704-332-5143

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	09/08/2025

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