Healthcare Provider Details

I. General information

NPI: 1952763138
Provider Name (Legal Business Name): EMBRACE ORTHOTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 S ROOSEVELT ST STE 2
ABERDEEN SD
57401-0300
US

IV. Provider business mailing address

708 S ROOSEVELT ST STE 2
ABERDEEN SD
57401-0300
US

V. Phone/Fax

Practice location:
  • Phone: 605-725-0061
  • Fax: 605-725-0062
Mailing address:
  • Phone: 605-725-0061
  • Fax: 605-725-0062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KELSEY HUBER
Title or Position: OWNER
Credential: BOCO, BOCPD, CFO
Phone: 605-359-6461