MEDICARE: MR. WILLIAM K ABBOTT CERTIFIED PROSTHETIS

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	225000000X	Orthotic Fitter	CERTIFIED	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	122475	OTHER	MO	BCBS PROVIDER#
2	433956	OTHER	MO	HEALTHLINK PROVIDER#

General Provider Information

NPI Number	:	1831133396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM K ABBOTT CERTIFIED PROSTHETIS

Provider Business Mailing Address
First Line	:	1735 SOUTHWEST BLVD
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-2435
Country	:	US
Telephone Number	:	573-635-0006
Fax Number	:	573-635-2228

Provider Business Practice Location Address
First Line	:	1735 SOUTHWEST BLVD
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-2435
Country	:	US
Telephone Number	:	573-635-0006
Fax Number	:	573-635-2228

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	11/08/2007

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