MEDICARE: OTTO BOCK ORTHOPEDIC SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	1313643	FL
2	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053623645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OTTO BOCK ORTHOPEDIC SERVICES LLC

Provider Business Mailing Address
First Line	:	PO BOX 734949
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-4949
Country	:	US
Telephone Number	:	512-806-2879
Fax Number	:	866-642-2302

Provider Business Practice Location Address
First Line	:	4061 BONITA BEACH RD STE 104
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-4073
Country	:	US
Telephone Number	:	800-736-8276
Fax Number	:	866-642-2302

Authorized Official
Title or Position	:	EVP OF LICENSURE
Name	:	KIMBERLY LEWIS
Credential	:
Telephone Number	:	512-806-2756

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	10/22/2025

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