Healthcare Provider Details

I. General information

NPI: 1740515782
Provider Name (Legal Business Name): OTTO BOCK ORTHOPEDIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11809 DOMAIN DR UNIT 110
AUSTIN TX
78758-3452
US

IV. Provider business mailing address

PO BOX 734949
DALLAS TX
75373-4949
US

V. Phone/Fax

Practice location:
  • Phone: 800-736-8276
  • Fax: 866-642-2302
Mailing address:
  • Phone: 800-736-8276
  • Fax: 866-642-2302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY LEWIS
Title or Position: EVP OF LICENSURE
Credential:
Phone: 512-806-2756