Healthcare Provider Details

I. General information

NPI: 1184219875
Provider Name (Legal Business Name): ORTHOTIC & PROSTHETIC SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 09/06/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 FAIRFIELD AVE STE E
SHREVEPORT LA
71104-2066
US

IV. Provider business mailing address

7754 FLORIDA BLVD
BATON ROUGE LA
70806-4706
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 225-243-9736
  • Fax: 985-256-2599

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: MR. DANDRE SHONDALE MOSTELLA
Title or Position: OWNER
Credential: CP
Phone: 225-316-5444