MEDICARE: PELICAN ORTHOTICS AND PROSTHETICS

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	:	1689250151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PELICAN ORTHOTICS AND PROSTHETICS

Provider Business Mailing Address
First Line	:	69156 HWY 190 SERV RD
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-5140
Country	:	US
Telephone Number	:	985-276-4560
Fax Number	:	985-276-4563

Provider Business Practice Location Address
First Line	:	69156 HWY 190 SERV RD
Second Line	:
City	:	COVINGTON
State	:	LA
Zip	:	70433-5140
Country	:	US
Telephone Number	:	985-276-4560
Fax Number	:	985-276-4563

Authorized Official
Title or Position	:	OWNER/CLINIC MANAGER
Name	:	JENNIFER CAPRITTO
Credential	:
Telephone Number	:	985-502-1841

Provider Enumeration Date	:	03/23/2021
Last Update Date	:	09/07/2021

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