=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154399814
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INNOVATIVE ORTHOTICS AND PROSTHETICS OF LA, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 WILLIAMS BLVD
-----------------------------------------------------
City | KENNER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70062-7638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-464-5577
-----------------------------------------------------
Fax | 504-464-5677
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 720 WILLIAMS BLVD
-----------------------------------------------------
City | KENNER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70062-7638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-464-5577
-----------------------------------------------------
Fax | 504-464-5677
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CERTIFIED PROSTHETIST/ORTHOTIST/
-----------------------------------------------------
Name | MR. WILLIAM S LAYMAN
-----------------------------------------------------
Credential | BOCPO, CPO
-----------------------------------------------------
Telephone | 504-464-5577
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------