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General NPI Number Information
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NPI Number | 1972326163
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Entity Type | Organization
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Legal Business Name | GREAT LAKES ORTHOTICS AND PROSTHETICS
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 2351 STONEBRIDGE DR
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City | FLINT
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State | MI
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Zip | 48532-5407
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Country | US
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Telephone | 601-594-2801
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Fax |
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Provider Business Mailing Address
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Address Line | 3124 ELK CREEK DR
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City | SWARTZ CREEK
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State | MI
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Zip | 48473-8630
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Country | US
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Telephone | 601-594-2801
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Fax |
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Authorized Official
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Title or Position | EMPLOYEE
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Name | TYNESHIA L MCFARLAND-WILLIAMS
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Credential |
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Telephone | 601-594-2801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225000000X
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Taxonomy Name | Orthotic Fitter
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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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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