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General NPI Number Information
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NPI Number | 1083623037
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Entity Type | Organization
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Legal Business Name | ORTHOTIC & PROSTHETIC SERVICES INC
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 05/01/2024
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Provider Practice Location Address
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Address Line | 283 E REAGAN PKWY
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City | MEDINA
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State | OH
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Zip | 44256-1298
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Country | US
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Telephone | 330-723-6679
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Fax | 330-722-7727
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Provider Business Mailing Address
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Address Line | 283 E REAGAN PKWY
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City | MEDINA
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State | OH
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Zip | 44256-1298
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Country | US
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Telephone | 330-723-6679
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Fax | 330-722-7727
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Authorized Official
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Title or Position | PRESIDENT/PRACTITIONER
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Name | JUSTIN PROCTOR
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Credential | C.P.O./L.P.O.
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Telephone | 330-723-6679
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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 | LPO202
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License Number State | OH
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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 | LPO202
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License Number State | OH
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