MEDICARE: CRAIG RICHARD DECAMP CPO

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

General Provider Information

NPI Number	:	1467949545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG RICHARD DECAMP CPO

Provider Business Mailing Address
First Line	:	2041 KLONDIKE RD
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-5122
Country	:	US
Telephone Number	:	765-463-4100
Fax Number	:	765-463-4112

Provider Business Practice Location Address
First Line	:	2041 KLONDIKE RD
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-5122
Country	:	US
Telephone Number	:	765-463-4100
Fax Number	:	765-463-4112

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

Provider Enumeration Date	:	04/16/2018
Last Update Date	:	04/16/2018

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