Healthcare Provider Details

I. General information

NPI: 1518610062
Provider Name (Legal Business Name): ORTHOTIC & PROSTHETIC SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 09/06/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 BEL AIR BLVD STE 303
MOBILE AL
36606-3507
US

IV. Provider business mailing address

7754 FLORIDA BLVD
BATON ROUGE LA
70806-4706
US

V. Phone/Fax

Practice location:
  • Phone: 225-316-4444
  • Fax: 985-256-2599
Mailing address:
  • Phone: 252-439-7362
  • Fax: 985-256-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANDRE SHONDALE MOSTELLA
Title or Position: OWNER
Credential: CP
Phone: 225-316-5444