Healthcare Provider Details

I. General information

NPI: 1669692497
Provider Name (Legal Business Name): ORTHOTICS AND PROSTHETICS ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10506 W BLUEMOUND RD
MILWAUKEE WI
53226-4332
US

IV. Provider business mailing address

10506 W BLUEMOUND RD
MILWAUKEE WI
53226-4332
US

V. Phone/Fax

Practice location:
  • Phone: 414-257-2727
  • Fax: 414-257-9898
Mailing address:
  • Phone: 414-257-2727
  • Fax: 414-257-9898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License NumberC.P. 1307
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name: JAKE RICHARD WOOD
Title or Position: PRESIDENT
Credential: C.P., F.A.A.O.P.
Phone: 414-257-2727