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General NPI Number Information
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NPI Number | 1467548479
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Entity Type | Organization
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Legal Business Name | ORTHOTICS PROSTHETICS ASSOC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 86 VICTORIA RD
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City | ASHEVILLE
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State | NC
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Zip | 28801
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Country | US
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Telephone | 828-254-0258
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Fax | 828-253-8603
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Provider Business Mailing Address
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Address Line | 86 VICTORIA RD
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City | ASHEVILLE
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State | NC
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Zip | 28801
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Country | US
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Telephone | 828-254-0258
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Fax | 828-253-8603
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KENNETH WUNDER
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Credential | CPO
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Telephone | 828-254-0258
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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 | 0700005812
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License Number State | NC
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