MEDICARE: CASEY LYNN PARHAM CPO/LPO

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	222Z00000X	Orthotist	1846	TX

General Provider Information

NPI Number	:	1306583612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY LYNN PARHAM CPO/LPO

Provider Business Mailing Address
First Line	:	1015 SWANSON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-5011
Country	:	US
Telephone Number	:	713-795-8909
Fax Number	:	713-795-4002

Provider Business Practice Location Address
First Line	:	1015 SWANSON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-5011
Country	:	US
Telephone Number	:	713-795-8909
Fax Number	:	713-795-4002

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

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	05/18/2022

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