Healthcare Provider Details

I. General information

NPI: 1437339710
Provider Name (Legal Business Name): ORTHOTIC & PROSTHETIC SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2007
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HIGHLAND PARK PLZ
COVINGTON LA
70433-7128
US

IV. Provider business mailing address

101 HIGHLAND PARK PLZ
COVINGTON LA
70433-7128
US

V. Phone/Fax

Practice location:
  • Phone: 985-898-6319
  • Fax: 985-867-8803
Mailing address:
  • Phone: 985-898-6319
  • 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: MICHAEL STEPHEN RELLE
Title or Position: PRESIDENT
Credential: CPO
Phone: 985-898-6319