Healthcare Provider Details

I. General information

NPI: 1174529937
Provider Name (Legal Business Name): ORTHOTIC PROSTHETIC CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 N REYNOLDS RD
TOLEDO OH
43615
US

IV. Provider business mailing address

419 N REYNOLDS RD
TOLEDO OH
43615
US

V. Phone/Fax

Practice location:
  • Phone: 419-531-2222
  • Fax: 419-531-2359
Mailing address:
  • Phone: 419-531-2222
  • Fax: 419-531-2359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberLO.56
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCO003462
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCP002589
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberLP.55
License Number StateOH

VIII. Authorized Official

Name: MRS. ANN M COLE
Title or Position: OWNER
Credential:
Phone: 419-531-2222