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General NPI Number Information
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NPI Number | 1164990040
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Entity Type | Organization
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Legal Business Name | COASTAL PROSTHETICS AND ORTHOTICS, LLC
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Dates
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Enumeration Date | 11/08/2018
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Last Update Date | 07/02/2019
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Provider Practice Location Address
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Address Line | 433 NETWORK STA
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3851
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Country | US
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Telephone | 757-892-5300
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Fax | 757-892-5303
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Provider Business Mailing Address
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Address Line | 433 NETWORK STA
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3851
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Country | US
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Telephone | 757-892-5300
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Fax | 757-892-5303
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KAREN VAUGHN
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Credential |
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Telephone | 757-828-5112
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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 |
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License Number State |
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