Healthcare Provider Details

I. General information

NPI: 1710969324
Provider Name (Legal Business Name): ABC PROSTHETICS AND ORTHOTICS DP OCOEE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10131 W COLONIAL DR UNIT 1
OCOEE FL
34761-4221
US

IV. Provider business mailing address

10131 W COLONIAL DR UNIT 1
OCOEE FL
34761-4221
US

V. Phone/Fax

Practice location:
  • Phone: 407-523-0495
  • Fax: 407-522-5078
Mailing address:
  • Phone: 407-523-0495
  • Fax: 407-522-5078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPOR41
License Number StateFL

VIII. Authorized Official

Name: WENDY M HARRIGAN
Title or Position: BILLING MANGER
Credential:
Phone: 407-341-5873