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General NPI Number Information
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NPI Number | 1356688303
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Entity Type | Organization
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Legal Business Name | NORTHLAND O&P LLC
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Dates
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Enumeration Date | 01/10/2013
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 115 BLUE JAY DR SUITE 107
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City | LIBERTY
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State | MO
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Zip | 64068-1900
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Country | US
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Telephone | 816-792-2412
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Fax |
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Provider Business Mailing Address
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Address Line | 115 BLUE JAY DR SUITE 107
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City | LIBERTY
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State | MO
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Zip | 64068-1900
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Country | US
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Telephone | 816-792-2412
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Fax |
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Authorized Official
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Title or Position | ORTHOTIST
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Name | MR. PAUL ARNOLD
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Credential |
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Telephone | 816-446-9250
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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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