=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841098308
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VAN DER WATT PROSTHETICS & ORTHOTICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2025
-----------------------------------------------------
Last Update Date | 03/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1090 FORT ST STE A
-----------------------------------------------------
City | BARLING
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72923-2159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-551-2462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1090 FORT ST
-----------------------------------------------------
City | BARLING
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72923-2159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-551-2462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | MR. FRANCOIS VAN DER WATT
-----------------------------------------------------
Credential | CPO
-----------------------------------------------------
Telephone | 479-357-1840
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------