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General NPI Number Information
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NPI Number | 1386599421
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Entity Type | Organization
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Legal Business Name | EAST SIDE ORTHOTICS & PROSTHETICS, INC.
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 19767 SW 72ND AVE STE 102
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City | TUALATIN
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State | OR
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Zip | 97062-8354
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Country | US
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Telephone | 503-257-6623
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Fax | 503-257-6624
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Provider Business Mailing Address
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Address Line | 17316 NE HALSEY ST
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City | PORTLAND
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State | OR
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Zip | 97230-6026
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Country | US
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Telephone | 503-257-6623
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Fax | 503-257-6624
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Authorized Official
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Title or Position | BILLING AND COMPLIANCE MANAGER
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Name | DANA SKJOLDAGER
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Credential |
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Telephone | 503-791-3197
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Z00000X
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Taxonomy Name | Orthotist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number |
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License Number State |
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