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General NPI Number Information
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NPI Number | 1174522015
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Entity Type | Organization
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Legal Business Name | SPECTRUM ORTHOTICS & PROSTHETICS INC
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 1963 THOMPSON RD
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City | COOS BAY
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State | OR
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Zip | 97420-2040
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Country | US
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Telephone | 541-269-1773
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Fax | 541-269-2790
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Provider Business Mailing Address
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Address Line | 1963 THOMPSON RD
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City | COOS BAY
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State | OR
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Zip | 97420-2040
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Country | US
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Telephone | 541-269-1773
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Fax | 541-269-2790
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH E CUZZORT
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Credential | CP
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Telephone | 541-269-1773
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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 | OR
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