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General NPI Number Information
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NPI Number | 1720023724
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Entity Type | Organization
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Legal Business Name | GREAT LAKES ORTHOTICS & PROSTHETICS INC.
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 3950 EVERGREEN CT STE A
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City | APPLETON
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State | WI
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Zip | 54913-8903
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Country | US
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Telephone | 920-968-2240
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Fax | 920-968-2241
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Provider Business Mailing Address
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Address Line | 3950 EVERGREEN CT STE A
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City | APPLETON
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State | WI
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Zip | 54913-8903
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Country | US
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Telephone | 920-968-2240
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Fax | 920-968-2241
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Authorized Official
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Title or Position | PRESIDENT
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Name | PERRY L ALGER
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Credential | CO
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Telephone | 920-968-2240
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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 |
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