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General NPI Number Information
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NPI Number | 1720397490
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Entity Type | Organization
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Legal Business Name | ACCESS PROSTHETICS LLC
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Dates
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Enumeration Date | 09/29/2010
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Last Update Date | 12/05/2016
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Provider Practice Location Address
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Address Line | 2020 RIVERSIDE DR 3RD FLOOR
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City | GREEN BAY
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State | WI
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Zip | 54301-2300
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Country | US
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Telephone | 920-471-1451
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Fax | 920-569-2939
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Provider Business Mailing Address
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Address Line | 2020 RIVERSIDE DR 3RD FLOOR
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City | GREEN BAY
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State | WI
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Zip | 54301-2300
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Country | US
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Telephone | 920-471-1451
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Fax | 920-569-2939
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRENTON M WATZKA
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Credential | CP
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Telephone | 920-680-0271
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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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