Healthcare Provider Details

I. General information

NPI: 1902005986
Provider Name (Legal Business Name): ASELAGE ORTHOTIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 LOUISIANA AVE STE 304
CORPUS CHRISTI TX
78404-2861
US

IV. Provider business mailing address

1001 LOUISIANA AVE STE 304
CORPUS CHRISTI TX
78404-2861
US

V. Phone/Fax

Practice location:
  • Phone: 361-854-2355
  • Fax: 361-854-5521
Mailing address:
  • Phone: 361-854-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number203
License Number StateTX

VIII. Authorized Official

Name: MS. CAROL ANN ASELAGE
Title or Position: OWNER
Credential: C.O.,L.O.
Phone: 361-854-2355