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General NPI Number Information
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NPI Number | 1861685083
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Entity Type | Organization
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Legal Business Name | TAMPA BAY ORTHOPAEDIC DESIGNS, INC.
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 667 S KINGS AVE
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City | BRANDON
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State | FL
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Zip | 33511-4885
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Country | US
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Telephone | 813-661-9162
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Fax | 813-662-9347
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Provider Business Mailing Address
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Address Line | 667 S KINGS AVE
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City | BRANDON
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State | FL
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Zip | 33511-6048
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Country | US
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Telephone | 813-661-9162
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Fax | 813-662-9347
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Authorized Official
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Title or Position | PRESIDENT
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Name | OLAF MICKLE HOLM
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Credential | PROSTHETIST/ORTHOTIS
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Telephone | 813-661-9162
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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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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | POR124
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License Number State | FL
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