MEDICARE: CERTIFIED ORTHOTIC & PROSTHETIC, INC

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	LPO144	OH

General Provider Information

NPI Number	:	1316124423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CERTIFIED ORTHOTIC & PROSTHETIC, INC

Provider Business Mailing Address
First Line	:	350 HILLCREST DR
Second Line	:
City	:	ASHLAND
State	:	OH
Zip	:	44805-4052
Country	:	US
Telephone Number	:	419-289-1900
Fax Number	:	419-289-1988

Provider Business Practice Location Address
First Line	:	350 HILLCREST DR
Second Line	:
City	:	ASHLAND
State	:	OH
Zip	:	44805-4052
Country	:	US
Telephone Number	:	419-289-1900
Fax Number	:	419-289-1988

Authorized Official
Title or Position	:	PRESIDENT/PRACTITIONER
Name	:	MR. STEVEN MARSHALL WILLIAMS
Credential	:	LPO
Telephone Number	:	419-289-1900

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	01/31/2008

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