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NPI Code Detail

MEDICARE: WILLAMETTE ORTHOTICS & PROSTHETICS LLC

MEDICARE: WILLAMETTE ORTHOTICS & PROSTHETICS 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
1335E00000XProsthetic/Orthotic Supplier

General Provider Information

NPI Number : 1104014877
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLAMETTE ORTHOTICS & PROSTHETICS LLC
Provider Business Mailing Address
First Line : PO BOX 7339
Second Line :
City : SALEM
State : OR
Zip : 97303-0102
Country : US
Telephone Number : 503-364-6006
Fax Number : 503-364-6046
Provider Business Practice Location Address
First Line : 2200 NE NEFF RD STE 307
Second Line :
City : BEND
State : OR
Zip : 97701-4279
Country : US
Telephone Number : 541-389-5422
Fax Number : 541-389-7656
Authorized Official
Title or Position : CEO
Name : IVAN SABEL
Credential :
Telephone Number : 503-364-6006
Provider Enumeration Date : 10/09/2007
Last Update Date : 05/12/2026

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Directions to “WILLAMETTE ORTHOTICS & PROSTHETICS LLC ” Practice Location

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