Healthcare Provider Details

I. General information

NPI: 1962409482
Provider Name (Legal Business Name): WISCONSIN PROSTHETICS & ORTHOTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 VELP AVE STE A
GREEN BAY WI
54303-6594
US

IV. Provider business mailing address

4714 GETTYSBURG RD
MECHANICSBURG PA
17055-4325
US

V. Phone/Fax

Practice location:
  • Phone: 920-435-3537
  • Fax: 920-435-3545
Mailing address:
  • Phone:
  • 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: MICHAEL E. TARVIN
Title or Position: VP & SECRETARY
Credential:
Phone: 717-972-1100