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General NPI Number Information
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NPI Number | 1720089253
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Entity Type | Organization
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Legal Business Name | DAYTON ARTIFICIAL LIMB CLINIC, INC.
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 700 HARCO DR
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City | CLAYTON
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State | OH
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Zip | 45315-8793
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Country | US
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Telephone | 937-898-2000
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Fax | 937-832-5361
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Provider Business Mailing Address
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Address Line | 700 HARCO DR
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City | CLAYTON
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State | OH
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Zip | 45315-8793
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Country | US
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Telephone | 937-898-2000
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Fax | 937-832-5361
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Authorized Official
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Title or Position | V P OF OPERATIONS
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Name | MS. LUCI BUSCH
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Credential | CP LP
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Telephone | 937-898-2200
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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 | LPO114
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License Number State | OH
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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 | CPO1502
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License Number State | OH
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