=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386898724
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LORETTA H. WEST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2008
-----------------------------------------------------
Last Update Date | 11/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 KING ST SUITE 600
-----------------------------------------------------
City | COHASSET
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02025-1396
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-383-8585
-----------------------------------------------------
Fax | 781-383-8282
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 LINCON STREET
-----------------------------------------------------
City | HULL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-718-9950
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LORETTA H WEST
-----------------------------------------------------
Credential | CFO
-----------------------------------------------------
Telephone | 781-383-8585
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------