Healthcare Provider Details

I. General information

NPI: 1669333076
Provider Name (Legal Business Name): OTTO BOCK PATIENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 HIGHWAY 34 E STE B
NEWNAN GA
30265-1330
US

IV. Provider business mailing address

PO BOX 737155
DALLAS TX
75373-7155
US

V. Phone/Fax

Practice location:
  • Phone: 770-271-5581
  • Fax:
Mailing address:
  • Phone:
  • 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