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General NPI Number Information
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NPI Number | 1710301825
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Entity Type | Organization
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Legal Business Name | AVON ORTHOTICS & PROSTHETICS
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Dates
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Enumeration Date | 02/10/2014
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Last Update Date | 05/23/2014
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Provider Practice Location Address
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Address Line | 6845 E US HIGHWAY 36 STE 450
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City | AVON
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State | IN
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Zip | 46123-9779
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Country | US
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Telephone | 870-351-7974
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Fax |
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Provider Business Mailing Address
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Address Line | 225 GETTYSBURG
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City | COATESVILLE
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State | IN
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Zip | 46121-8957
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Country | US
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Telephone | 870-351-7974
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN ANDREW SHORT
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Credential | C.PED C.O.F.
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Telephone | 870-351-7974
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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 |
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License Number State | IN
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