Healthcare Provider Details

I. General information

NPI: 1275767147
Provider Name (Legal Business Name): ORTHOTICS & PROSTHETICS LABORATORIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 MAIN ST STE 101
SPRINGFIELD MA
01107-1148
US

IV. Provider business mailing address

300 BIRNIE AVE SUITE 303
SPRINGFIELD MA
01107-1107
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 TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCO004133
License Number State

VIII. Authorized Official

Name: MR. JAMES HAAS
Title or Position: PRESIDENT
Credential: C.O.
Phone: 413-737-2404