Healthcare Provider Details

I. General information

NPI: 1407025224
Provider Name (Legal Business Name): HOWARD ORTHOTICS AND PROSTHETICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 SHERMAN ST
WATERTOWN NY
13601-3614
US

IV. Provider business mailing address

316 SHERMAN STREET
WATERTOWN NY
13601-2729
US

V. Phone/Fax

Practice location:
  • Phone: 315-786-0655
  • Fax: 315-786-7993
Mailing address:
  • Phone: 315-786-8973
  • Fax: 315-786-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: WENDY STAUB
Title or Position: VPA/INCOME MANAGER
Credential:
Phone: 315-786-8973