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General NPI Number Information
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NPI Number | 1790424828
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Entity Type | Organization
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Legal Business Name | NORTHERN ORTHOTICS & PROSTHETICS
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Dates
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Enumeration Date | 05/27/2022
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 1115 S HEMLOCK ST
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City | IRON MOUNTAIN
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State | MI
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Zip | 49801-3800
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Country | US
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Telephone | 906-553-7350
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Fax |
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Provider Business Mailing Address
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Address Line | 1015 COMMERCE DR
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City | MARQUETTE
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State | MI
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Zip | 49855-8694
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Country | US
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Telephone | 190-645-8471
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ROBIN ROY
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Credential |
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Telephone | 906-273-2444
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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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