Healthcare Provider Details

I. General information

NPI: 1699317784
Provider Name (Legal Business Name): PREFERRED ORTHOTIC AND PROSTHETIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S COWLEY ST STE 104
SPOKANE WA
99202-1315
US

IV. Provider business mailing address

8880 SW NIMBUS AVE STE A
BEAVERTON OR
97008-7111
US

V. Phone/Fax

Practice location:
  • Phone: 509-866-4460
  • Fax: 509-866-4461
Mailing address:
  • Phone: 503-765-5081
  • Fax: 503-765-5081

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: TIMOTHY L O'NEILL
Title or Position: OWNER
Credential: CPO
Phone: 503-407-5408