=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154734317
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KESSLER-HEASLEY ARTIFICIAL LIMB CO.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2014
-----------------------------------------------------
Last Update Date | 12/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2312 CONNECTCUT
-----------------------------------------------------
City | JOPLIN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64804-3039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-659-8488
-----------------------------------------------------
Fax | 417-659-8486
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3250 S DELAWARE AVE
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65804-6486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-889-3222
-----------------------------------------------------
Fax | 417-889-3223
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | ANGIE JON MUGGENBURG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 417-889-3222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------