=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316124423
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CERTIFIED ORTHOTIC & PROSTHETIC, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2008
-----------------------------------------------------
Last Update Date | 01/31/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 HILLCREST DR
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44805-4052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-289-1900
-----------------------------------------------------
Fax | 419-289-1988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350 HILLCREST DR
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44805-4052
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-289-1900
-----------------------------------------------------
Fax | 419-289-1988
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PRACTITIONER
-----------------------------------------------------
Name | MR. STEVEN MARSHALL WILLIAMS
-----------------------------------------------------
Credential | LPO
-----------------------------------------------------
Telephone | 419-289-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | LPO144
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------