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NPI Code Detail

MEDICARE: PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES- WEST, LLC

MEDICARE: PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES- WEST, 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 SupplierUT

General Provider Information

NPI Number : 1225430150
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES- WEST, LLC
Provider Business Mailing Address
First Line : PO BOX 865109
Second Line :
City : ORLANDO
State : FL
Zip : 32886-5109
Country : US
Telephone Number : 844-602-3960
Fax Number : 813-281-8461
Provider Business Practice Location Address
First Line : 1275 E FAIRFAX RD
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84103-4324
Country : US
Telephone Number : 801-536-3820
Fax Number : 801-536-3731
Authorized Official
Title or Position : DIRECTOR
Name : DAVID R DRAPER
Credential : CPO
Telephone Number : 801-536-3827
Provider Enumeration Date : 09/23/2014
Last Update Date : 07/23/2015

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