MEDICARE: ORTHOTIC & PROSTHETICS INTERNATIONAL

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
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1679305056
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOTIC & PROSTHETICS INTERNATIONAL

Provider Business Mailing Address
First Line	:	4347 PORTAGE ST NW STE 103
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-7371
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4347 PORTAGE ST NW STE 103
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-7371
Country	:	US
Telephone Number	:	330-244-9058
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PRESTON NEWBOLD
Credential	:
Telephone Number	:	330-244-9058

Provider Enumeration Date	:	08/15/2024
Last Update Date	:	02/19/2025

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