Healthcare Provider Details

I. General information

NPI: 1487621298
Provider Name (Legal Business Name): AROOSTOOK ORTHOTICS AND PROSTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 NORTH STREET SUITE 6
PRESQUE ISLE ME
04769
US

IV. Provider business mailing address

40 NORTH STREET SUITE 6 PO BOX 269
PRESQUE ISLE ME
04769
US

V. Phone/Fax

Practice location:
  • Phone: 207-762-3808
  • Fax: 207-762-3809
Mailing address:
  • Phone: 207-762-3808
  • Fax: 207-762-3809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number1049058
License Number StateME

VIII. Authorized Official

Name: MRS. DONNA L GALLANT
Title or Position: OWNER
Credential: BOCO CPED CMF
Phone: 207-762-3808