MEDICARE: SNELL PROSTHETIC & ORTHOTIC LABORATORY

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	:	1558131102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SNELL PROSTHETIC & ORTHOTIC LABORATORY

Provider Business Mailing Address
First Line	:	625 N UNIVERSITY AVE
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-2917
Country	:	US
Telephone Number	:	501-664-2624
Fax Number	:	501-664-1708

Provider Business Practice Location Address
First Line	:	3400 S 70TH ST STE A
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-5292
Country	:	US
Telephone Number	:	479-223-5980
Fax Number	:	479-269-1374

Authorized Official
Title or Position	:	COO
Name	:	BRANT E. SNELL
Credential	:	LOPA
Telephone Number	:	501-664-2624

Provider Enumeration Date	:	01/04/2024
Last Update Date	:	01/09/2024

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Directions to “SNELL PROSTHETIC & ORTHOTIC LABORATORY ” Practice Location

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