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General NPI Number Information
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NPI Number | 1124075833
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Entity Type | Organization
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Legal Business Name | SCOTT SABOLICH PROSTHETICS & RESEARCH LLC
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 10201 BROADWAY EXT
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City | OKLAHOMA CITY
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State | OK
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Zip | 73114-6217
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Country | US
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Telephone | 405-463-0203
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Fax | 405-463-0251
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Provider Business Mailing Address
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Address Line | PO BOX 16231
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City | OKLAHOMA CITY
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State | OK
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Zip | 73113-2231
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Country | US
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Telephone | 405-463-0203
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Fax | 405-463-0251
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Authorized Official
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Title or Position | EVP OF LICENSURE & ACCREDITATION
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Name | KIMBERLY ANN LEWIS
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Credential | CPCO
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Telephone | 512-806-2861
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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 | CP2626
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License Number State | OK
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