Healthcare Provider Details

I. General information

NPI: 1003046277
Provider Name (Legal Business Name): WILLAMETTE ORTHOTICS & PROSTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 WILLAGILLESPIE RD SUITE B
EUGENE OR
97401-2106
US

IV. Provider business mailing address

PO BOX 7339
SALEM OR
97303-0102
US

V. Phone/Fax

Practice location:
  • Phone: 541-743-0612
  • Fax: 541-743-0613
Mailing address:
  • Phone: 503-364-6006
  • Fax: 503-364-6046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TODD J NELSON
Title or Position: PRESIDENT
Credential:
Phone: 503-364-6006