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General NPI Number Information
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NPI Number | 1053623645
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Entity Type | Organization
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Legal Business Name | OTTO BOCK ORTHOPEDIC SERVICES LLC
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Dates
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Enumeration Date | 07/12/2010
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 4061 BONITA BEACH RD STE 104
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-4073
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Country | US
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Telephone | 800-736-8276
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Fax | 866-642-2302
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Provider Business Mailing Address
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Address Line | PO BOX 734949
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City | DALLAS
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State | TX
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Zip | 75373-4949
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Country | US
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Telephone | 512-806-2879
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Fax | 866-642-2302
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Authorized Official
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Title or Position | EVP OF LICENSURE
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Name | KIMBERLY LEWIS
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Credential |
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Telephone | 512-806-2756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1313643
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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