Healthcare Provider Details

I. General information

NPI: 1033272638
Provider Name (Legal Business Name): ORTHOTIC & PROSTHETIC ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1557 SPRING HILL AVE STE A
MOBILE AL
36604-3218
US

IV. Provider business mailing address

1557 SPRING HILL AVE STE A
MOBILE AL
36604-3218
US

V. Phone/Fax

Practice location:
  • Phone: 251-433-0400
  • Fax: 251-433-9940
Mailing address:
  • Phone: 251-433-0400
  • Fax: 251-433-9940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number25
License Number StateAL

VIII. Authorized Official

Name: SELINA R GIBSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 251-433-0400