Healthcare Provider Details

I. General information

NPI: 1316764129
Provider Name (Legal Business Name): CUPELES DESIGNS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 CHESTNUT ST STE 150
LEBANON PA
17042-6139
US

IV. Provider business mailing address

PO BOX 143
LEBANON PA
17042-0143
US

V. Phone/Fax

Practice location:
  • Phone: 717-673-0063
  • Fax:
Mailing address:
  • Phone: 717-673-0063
  • 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: YADIRA CUPELES
Title or Position: OWNER
Credential:
Phone: 717-673-0063