Healthcare Provider Details

I. General information

NPI: 1285598656
Provider Name (Legal Business Name): LE POSTICHE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 N PENNSYLVANIA AVE
OKLAHOMA CITY OK
73112-7769
US

IV. Provider business mailing address

13109 BOX CANYON RD
OKLAHOMA CITY OK
73142-6203
US

V. Phone/Fax

Practice location:
  • Phone: 405-849-5779
  • Fax:
Mailing address:
  • Phone: 918-344-8843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ANDREW MARYADI
Title or Position: OWNER
Credential:
Phone: 918-344-8843