Healthcare Provider Details

I. General information

NPI: 1679564546
Provider Name (Legal Business Name): ORTHOTICS & PROSTHETICS LABORATORIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 MAIN ST STE 101
SPRINGFIELD MA
01107-1150
US

IV. Provider business mailing address

3500 MAIN ST STE 101
SPRINGFIELD MA
01107-1150
US

V. Phone/Fax

Practice location:
  • Phone: 413-737-2404
  • Fax: 413-733-1389
Mailing address:
  • Phone: 413-737-2404
  • Fax: 413-733-1389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: IVAN SABEL
Title or Position: CEO
Credential:
Phone: 413-737-2404