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General NPI Number Information
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NPI Number | 1881643807
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Entity Type | Organization
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Legal Business Name | OWENS CAROLINA ORTHOTIC & PROSTHETIC NETWORK, INC.
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 3535 RANDOLPH RD STE 210
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City | CHARLOTTE
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State | NC
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Zip | 28211-5027
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Country | US
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Telephone | 704-332-5143
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Fax | 866-670-5370
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Provider Business Mailing Address
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Address Line | PO BOX 1268
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City | FORT MILL
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State | SC
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Zip | 29716-1268
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Country | US
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Telephone | 704-332-5143
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Fax | 866-670-5370
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SUSAN WALLACE
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Credential | MHCA
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Telephone | 704-332-5143
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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 | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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