Healthcare Provider Details

I. General information

NPI: 1871775668
Provider Name (Legal Business Name): O & P CLINICAL TECHNOLOGIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 NW 39TH AVE STE G
GAINESVILLE FL
32606-6090
US

IV. Provider business mailing address

4650 NW 39TH AVE STE G
GAINESVILLE FL
32606-6090
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-4221
  • Fax: 352-332-8074
Mailing address:
  • Phone: 352-331-4221
  • Fax: 352-332-8074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberPOR56
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPOR56
License Number StateFL

VIII. Authorized Official

Name: PAUL E. PRUSAKOWSKI
Title or Position: PRESIDENT/CEO
Credential: LPO, CPO, FAAOP
Phone: 352-331-4221