Healthcare Provider Details

I. General information

NPI: 1063497238
Provider Name (Legal Business Name): SNELL PROSTHETIC & ORTHOTIC LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2005
Last Update Date: 01/05/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 WARDEN RD, STE B
NORTH LITTLE ROCK AR
72117
US

IV. Provider business mailing address

625 N UNIVERSITY AVE
LITTLE ROCK AR
72205-2917
US

V. Phone/Fax

Practice location:
  • Phone: 501-945-5462
  • Fax: 501-945-1381
Mailing address:
  • Phone: 501-664-2624
  • Fax: 501-664-1708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number04734178001
License Number StateAR

VIII. Authorized Official

Name: BRANT E. SNELL
Title or Position: COO
Credential: LPOA
Phone: 501-664-2624