Healthcare Provider Details

I. General information

NPI: 1134164544
Provider Name (Legal Business Name): ORTHOTIC AND PROSTHETIC CENTER OF BOSTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 11/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126B MID TECH DR
WEST YARMOUTH MA
02673-2560
US

IV. Provider business mailing address

126B MID TECH DR
WEST YARMOUTH MA
02673-2560
US

V. Phone/Fax

Practice location:
  • Phone: 508-775-2570
  • Fax: 508-775-7609
Mailing address:
  • Phone: 508-775-2570
  • Fax: 508-775-7609

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. JAMES TIERNEY
Title or Position: PRESIDENT
Credential:
Phone: 508-775-2570