MEDICARE: ORTHOTIC AND PROSTHETIC LAB, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1649331596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOTIC AND PROSTHETIC LAB, INC

Provider Business Mailing Address
First Line	:	748 MARSHALL AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63119-1924
Country	:	US
Telephone Number	:	314-968-8555
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 NORTH NEW BALLAS COURT
Second Line	:	SUITE 320
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-7169
Country	:	US
Telephone Number	:	314-567-6110
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DAVID J OSTERMAN
Credential	:
Telephone Number	:	314-968-8555

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	08/22/2020

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