Healthcare Provider Details

I. General information

NPI: 1881643807
Provider Name (Legal Business Name): OWENS CAROLINA ORTHOTIC & PROSTHETIC NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 RANDOLPH RD STE 210
CHARLOTTE NC
28211-5027
US

IV. Provider business mailing address

PO BOX 1268
FORT MILL SC
29716-1268
US

V. Phone/Fax

Practice location:
  • Phone: 704-332-5143
  • Fax: 866-670-5370
Mailing address:
  • Phone: 704-332-5143
  • Fax: 866-670-5370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: SUSAN WALLACE
Title or Position: ADMINISTRATOR
Credential:
Phone: 704-332-5143