Healthcare Provider Details

I. General information

NPI: 1528770518
Provider Name (Legal Business Name): OTTO BOCK PATIENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 W LINCOLN HWY
EXTON PA
19341-2514
US

IV. Provider business mailing address

11809 DOMAIN DR UNIT 100
AUSTIN TX
78758-3452
US

V. Phone/Fax

Practice location:
  • Phone: 610-873-6733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: PALLAVI NEMANI
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 512-552-6311