=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811095516
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OLD DOMINION PROSTHETICS & ORTHOTICS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1920 MEDICAL AVE SUITE G
-----------------------------------------------------
City | HARRISONBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22801-8016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-433-3831
-----------------------------------------------------
Fax | 540-433-5447
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1920 MEDICAL AVE SUITE G
-----------------------------------------------------
City | HARRISONBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22801-8016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-433-3831
-----------------------------------------------------
Fax | 540-433-5447
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | MRS. CATHERINE B GARRISON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 434-973-6209
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------