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General NPI Number Information
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NPI Number | 1932853876
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Entity Type | Organization
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Legal Business Name | KJL PROSTHESIS
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Dates
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Enumeration Date | 02/09/2022
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 4530 S ORANGE BLOSSOM TRL # 594
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City | ORLANDO
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State | FL
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Zip | 32839-1704
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Country | US
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Telephone | 321-444-2110
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Fax | 321-275-3775
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Provider Business Mailing Address
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Address Line | 4530 S ORANGE BLOSSOM TRL # 594
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City | ORLANDO
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State | FL
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Zip | 32839-1704
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Country | US
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Telephone | 321-444-2110
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Fax | 321-275-3775
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Authorized Official
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Title or Position | OWNER
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Name | KINNY MCLAREN
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Credential |
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Telephone | 321-444-2110
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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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