Healthcare Provider Details

I. General information

NPI: 1710221197
Provider Name (Legal Business Name): WESTERN CAROLINA O & P
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 E WALKER ST
EAST FLAT ROCK NC
28726-2235
US

IV. Provider business mailing address

107 EAST WALKER STREET
EAST FLAT ROCK NC
28726
US

V. Phone/Fax

Practice location:
  • Phone: 828-595-9371
  • Fax: 828-595-9373
Mailing address:
  • Phone: 828-595-9371
  • Fax: 828-595-9373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. KELLY WIGGEN
Title or Position: PRACTICE MANAGER
Credential: COF
Phone: 828-595-9371