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General NPI Number Information
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NPI Number | 1760694814
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Entity Type | Organization
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Legal Business Name | COMPRESSION STOCKINGS PLUS INC.
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 460 N. RONALD REAGAN BLVD SUITE 206
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City | LONGWOOD
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State | FL
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Zip | 32750
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Country | US
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Telephone | 407-331-1314
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Fax | 407-650-3074
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Provider Business Mailing Address
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Address Line | 460 N. RONALD REAGAN BLVD SUITE 206
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City | LONGWOOD
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State | FL
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Zip | 32750
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Country | US
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Telephone | 407-331-1314
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Fax | 407-650-3074
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN OYAGHIRE IDEHEN
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Credential | THERAPIST
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Telephone | 407-331-1314
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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 | OT7106 AND OTA213
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License Number State | FL
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