MEDICARE: SPECIALIZED ORTHOTIC & PROSTHETIC TECHNOLOGIES

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	:	1871729939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALIZED ORTHOTIC & PROSTHETIC TECHNOLOGIES

Provider Business Mailing Address
First Line	:	5292 COLLEGE DR STE 103
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84123-2958
Country	:	US
Telephone Number	:	801-266-7768
Fax Number	:

Provider Business Practice Location Address
First Line	:	5292 COLLEGE DR STE 103
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84123-2958
Country	:	US
Telephone Number	:	801-266-7768
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF REIMBURSEMENT
Name	:	SHERYL PRICE
Credential	:
Telephone Number	:	503-493-8288

Provider Enumeration Date	:	06/03/2009
Last Update Date	:	06/03/2009

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Directions to “SPECIALIZED ORTHOTIC & PROSTHETIC TECHNOLOGIES ” Practice Location

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