=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134636426
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHOTICS & PROSTHETICS LABORATORIES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2018
-----------------------------------------------------
Last Update Date | 04/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3500 MAIN ST STE 101
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01107-1148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-737-2404
-----------------------------------------------------
Fax | 413-733-1389
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3500 MAIN ST STE 101
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01107-1150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-737-2404
-----------------------------------------------------
Fax | 413-733-1389
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JAMES HAAS
-----------------------------------------------------
Credential | CO
-----------------------------------------------------
Telephone | 413-737-2404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------