Healthcare Provider Details

I. General information

NPI: 1760431951
Provider Name (Legal Business Name): ORTHOTICS WEST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 GRANBY RD
SOUTH HADLEY MA
01075-2145
US

IV. Provider business mailing address

3455 MAIN ST
SPRINGFIELD MA
01107-1147
US

V. Phone/Fax

Practice location:
  • Phone: 413-534-7465
  • Fax: 413-534-7466
Mailing address:
  • Phone: 413-736-3000
  • Fax: 413-739-3000

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: DONNA REED
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 413-736-3000