Provider Demographics
NPI:1154649325
Name:ORTHOTICS AND PROSTHETICS ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ORTHOTICS AND PROSTHETICS ASSOCIATES, INC.
Other - Org Name:O & P ASSOCIATES, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:CP, FAAOP
Authorized Official - Phone:262-436-0079
Mailing Address - Street 1:10506 W BLUEMOUND RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4332
Mailing Address - Country:US
Mailing Address - Phone:414-257-2727
Mailing Address - Fax:414-257-9898
Practice Address - Street 1:1111 DELAFIELD ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-3417
Practice Address - Country:US
Practice Address - Phone:262-436-0079
Practice Address - Fax:262-436-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIC.P. 13071744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41785600Medicaid
WI41785600Medicaid