Healthcare Provider Details

I. General information

NPI: 1174522015
Provider Name (Legal Business Name): SPECTRUM ORTHOTICS & PROSTHETICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1963 THOMPSON RD
COOS BAY OR
97420-2040
US

IV. Provider business mailing address

1963 THOMPSON RD
COOS BAY OR
97420-2040
US

V. Phone/Fax

Practice location:
  • Phone: 541-269-1773
  • Fax: 541-269-2790
Mailing address:
  • Phone: 541-269-1773
  • Fax: 541-269-2790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOSEPH E CUZZORT
Title or Position: OWNER
Credential: CP
Phone: 541-269-1773