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General NPI Number Information
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NPI Number | 1649411554
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Entity Type | Organization
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Legal Business Name | GREAT STRIDES
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 335 HIGHLAND AVE
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City | CHESHIRE
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State | CT
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Zip | 06410-2549
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Country | US
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Telephone | 203-272-7862
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Fax |
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Provider Business Mailing Address
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Address Line | 689 YALESVILLE RD
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City | CHESHIRE
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State | CT
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Zip | 06410-2932
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Country | US
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Telephone | 203-272-7862
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Fax | 203-272-3834
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | JOHN HOYT OLIN
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Credential | C.O.
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Telephone | 203-272-7862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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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 | 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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