MEDICARE: MR. KENNETH CAPRITTO C.O., BOCP

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1275075699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH CAPRITTO C.O., BOCP

Provider Business Mailing Address
First Line	:	69156 HIGHWAY 190 SERVICE RD
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-5140
Country	:	US
Telephone Number	:	985-966-3484
Fax Number	:

Provider Business Practice Location Address
First Line	:	69156 HIGHWAY 190 SERVICE RD
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-5140
Country	:	US
Telephone Number	:	985-966-3484
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2016
Last Update Date	:	09/07/2021

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