MEDICARE: O&P CLINICAL TECHNOLOGIES INC

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	332BC3200X	Customized Equipment (DME)	POR56	FL
2	335E00000X	Prosthetic/Orthotic Supplier	POR56	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000849796O	OTHER	ABC
2	6MYL2	OTHER	CAGE
3	NB7TG45GY7L5	OTHER	SAM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871775668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	O&P CLINICAL TECHNOLOGIES INC

Provider Business Mailing Address
First Line	:	4650 NW 39TH AVE STE G
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-6090
Country	:	US
Telephone Number	:	352-331-4221
Fax Number	:	352-332-8074

Provider Business Practice Location Address
First Line	:	4650 NW 39TH AVE STE G
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-6090
Country	:	US
Telephone Number	:	352-331-4221
Fax Number	:	352-332-8074

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	PAUL EDWARD PRUSAKOWSKI
Credential	:	LPO, CPO, FAAOP
Telephone Number	:	352-331-4221

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	03/12/2026

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Directions to “O&P CLINICAL TECHNOLOGIES INC ” Practice Location

Language	Start Address	Practice Location

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