Healthcare Provider Details

I. General information

NPI: 1215951983
Provider Name (Legal Business Name): AMERICAN ORTHO-TECH LABORATORIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W GRANADA BLVD STE 3
ORMOND BEACH FL
32174-8104
US

IV. Provider business mailing address

1414 W GRANADA BLVD STE 3
ORMOND BEACH FL
32174-8104
US

V. Phone/Fax

Practice location:
  • Phone: 386-258-0401
  • Fax: 386-252-1013
Mailing address:
  • Phone: 386-258-0401
  • Fax: 386-252-1013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberPOR142
License Number StateFL

VIII. Authorized Official

Name: JANET WOODALL
Title or Position: DIRECTOR, CONTRACTING
Credential:
Phone: 336-397-0993