Healthcare Provider Details

I. General information

NPI: 1407852023
Provider Name (Legal Business Name): ADAM JOHN LEHOTAY CP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LEHOTAY PROSTHETICS, LLC

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 GEORGIA ST
CHARLESTON WV
25302-1801
US

IV. Provider business mailing address

615 GEORGIA ST
CHARLESTON WV
25302-1801
US

V. Phone/Fax

Practice location:
  • Phone: 304-344-0036
  • Fax: 304-344-5025
Mailing address:
  • Phone: 304-344-0036
  • Fax: 304-344-5025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCP2217
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: