Healthcare Provider Details

I. General information

NPI: 1982671640
Provider Name (Legal Business Name): ACCESS ABILITY ORTHOTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 CHERRY LANE CT SUITE 213
LAUREL MD
20707-4958
US

IV. Provider business mailing address

14300 CHERRY LANE CT SUITE 213
LAUREL MD
20707-4958
US

V. Phone/Fax

Practice location:
  • Phone: 301-776-5200
  • Fax: 301-776-4480
Mailing address:
  • Phone: 301-776-5200
  • Fax: 301-776-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCO001692
License Number StateMD

VIII. Authorized Official

Name: MR. DAVID RANDY HARRIS
Title or Position: OWNER
Credential: C.O.
Phone: 301-776-5200