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General NPI Number Information
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NPI Number | 1447250055
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Entity Type | Organization
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Legal Business Name | LAURIE DOWELL
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 704 S BOIS D ARC AVE
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City | TYLER
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State | TX
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Zip | 75701-1503
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Country | US
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Telephone | 903-592-4737
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Fax | 903-535-9028
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Provider Business Mailing Address
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Address Line | 1910 ESE LOOP323 #119
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City | TYLER
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State | TX
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Zip | 75701-8337
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Country | US
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Telephone | 903-542-4737
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Fax | 903-535-9028
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | MS. LAURIE M DOWELL
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Credential | CP LP FAA OP
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Telephone | 903-592-4737
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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 | 466
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License Number State | TX
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