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General NPI Number Information
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NPI Number | 1053811174
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Entity Type | Organization
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Legal Business Name | CENTRAL ORTHOTICS LLC
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Dates
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Enumeration Date | 02/15/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 431 FRONT ST
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City | REPUBLIC
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State | MI
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Zip | 49879-9100
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Country | US
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Telephone | 906-376-8000
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Fax | 616-884-8119
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Provider Business Mailing Address
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Address Line | 431 FRONT ST
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City | REPUBLIC
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State | MI
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Zip | 49879-9100
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Country | US
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Telephone | 906-376-8000
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Fax | 616-884-8119
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Authorized Official
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Title or Position | ORTHOTIST/OWNER
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Name | JON RICHARD TAPIO
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Credential | BOCO
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Telephone | 906-376-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | BOCS60682
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License Number State |
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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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Taxonomy #3
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 5306004871
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License Number State | MI
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