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General NPI Number Information
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NPI Number | 1104801125
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Entity Type | Organization
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Legal Business Name | CAROLINA ORTHOTICS AND PROSTHETICS LLC
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 3465 W MONTAGUE AVE STE 101
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City | N CHARLESTON
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State | SC
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Zip | 29418-5938
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Country | US
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Telephone | 843-577-9577
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Fax | 843-577-9574
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Provider Business Mailing Address
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Address Line | 4975 LACROSS RD STE 314
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-6531
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Country | US
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Telephone | 843-577-9577
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Fax | 843-718-1438
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Authorized Official
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Title or Position | COO
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Name | DAVID VICK
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Credential |
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Telephone | 843-577-9577
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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 |
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License Number State |
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