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General NPI Number Information
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NPI Number | 1134438898
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Entity Type | Organization
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Legal Business Name | ABC ORTHOTICS & PROSTHETICS CULLMAN, LLC
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Dates
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Enumeration Date | 09/29/2010
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 501 MAIN AVE SW
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City | CULLMAN
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State | AL
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Zip | 35055-4728
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Country | US
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Telephone | 256-775-6041
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Fax | 256-775-6058
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Provider Business Mailing Address
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Address Line | 501 MAIN AVE SW
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City | CULLMAN
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State | AL
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Zip | 35055-4728
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Country | US
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Telephone | 256-775-6041
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Fax | 256-775-6052
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Authorized Official
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Title or Position | MANAGER
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Name | ALEISHA MULLINS HARVEY
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Credential | CMF,CPOA
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Telephone | 256-775-6041
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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 | 15827
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License Number State | AL
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