Healthcare Provider Details

I. General information

NPI: 1679305056
Provider Name (Legal Business Name): ORTHOTIC & PROSTHETICS INTERNATIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4347 PORTAGE ST NW STE 103
NORTH CANTON OH
44720-7371
US

IV. Provider business mailing address

4347 PORTAGE ST NW STE 103
NORTH CANTON OH
44720-7371
US

V. Phone/Fax

Practice location:
  • Phone: 330-244-9058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: PRESTON NEWBOLD
Title or Position: OWNER
Credential:
Phone: 330-244-9058