Healthcare Provider Details

I. General information

NPI: 1881771640
Provider Name (Legal Business Name): WILMINGTON ORTHOTICS & PROSTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3909 OLEANDER DR STE E
WILMINGTON NC
28403-6714
US

IV. Provider business mailing address

3909 OLEANDER DR STE E
WILMINGTON NC
28403-6714
US

V. Phone/Fax

Practice location:
  • Phone: 910-395-5775
  • Fax: 910-395-5773
Mailing address:
  • Phone: 910-395-5775
  • Fax: 910-395-5773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. MARISKA TRUESDALE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 910-395-5775