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NPI Code Detail

MEDICARE: CAROLYN MCCANN CP

MEDICARE: CAROLYN MCCANN CP
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
1335E00000XProsthetic/Orthotic Supplier

General Provider Information

NPI Number : 1861924706
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN MCCANN CP
Provider Business Mailing Address
First Line : 408 E WASHINGTON ST
Second Line :
City : BUTLER
State : IN
Zip : 46721-1179
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1900 N MERIDIAN ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-1304
Country : US
Telephone Number : 317-296-7330
Fax Number : 317-296-7329
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2017
Last Update Date : 03/30/2017

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