Healthcare Provider Details

I. General information

NPI: 1760180731
Provider Name (Legal Business Name): OTTO BOCK PATIENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 N 15TH ST STE 105
PHOENIX AZ
85020-4330
US

IV. Provider business mailing address

11809 DOMAIN DR UNIT 400
AUSTIN TX
78758-3452
US

V. Phone/Fax

Practice location:
  • Phone: 602-745-2080
  • Fax:
Mailing address:
  • Phone: 800-328-4058
  • Fax:

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: PALLAVI CHINTAPALLI NEMANI
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 512-552-6311