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	:	1922857218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OTTO BOCK PATIENT CARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 737155
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-7155
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1604 STONE ST
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3344
Country	:	US
Telephone Number	:	810-385-6330
Fax Number	:

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

Provider Enumeration Date	:	05/17/2024
Last Update Date	:	05/17/2024

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