Healthcare Provider Details

I. General information

NPI: 1912289216
Provider Name (Legal Business Name): CYNTHIA VESTAL TIERNEY BOCO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TIERNEY ORTHOTICS AND PROSTHETICS INC 1345 WESTGATE CENTER DR, STE B
WINSTON SALEM NC
27103
US

IV. Provider business mailing address

1345 WESTGATE CENTER DR. STE B
WINSTON SALEM NC
27103
US

V. Phone/Fax

Practice location:
  • Phone: 336-546-7165
  • Fax: 866-403-2483
Mailing address:
  • Phone: 336-546-7165
  • Fax: 866-403-2483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: