MEDICARE: OTTO BOCK PATIENT CARE, LLC

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	:	1841980539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OTTO BOCK PATIENT CARE, LLC

Provider Business Mailing Address
First Line	:	11809 DOMAIN DR UNIT 400
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-3452
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1294 PROFESSIONAL DR STE B
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5753
Country	:	US
Telephone Number	:	843-497-9558
Fax Number	:

Authorized Official
Title or Position	:	COMPLIANCE OFFICER
Name	:	PALLAVI CHINTAPALLI NEMANI
Credential	:
Telephone Number	:	512-552-6311

Provider Enumeration Date	:	05/08/2023
Last Update Date	:	05/08/2023

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