MEDICARE: COASTAL ORTHOTICS AND PROSTHETICS 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	G5261	OTHER	LA	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1932101227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL ORTHOTICS AND PROSTHETICS LLC

Provider Business Mailing Address
First Line	:	4600 HIGHWAY 22
Second Line	:	STE 1
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-2891
Country	:	US
Telephone Number	:	985-626-1135
Fax Number	:	985-626-1174

Provider Business Practice Location Address
First Line	:	4600 HIGHWAY 22 STE 1
Second Line	:
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-2891
Country	:	US
Telephone Number	:	985-626-1135
Fax Number	:	985-626-1174

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SEAN NORTHEY
Credential	:	C.P./C.O.F.
Telephone Number	:	985-626-1135

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/21/2025

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Directions to “COASTAL ORTHOTICS AND PROSTHETICS LLC ” Practice Location

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