Provider Demographics
NPI:1184219875
Name:ORTHOTIC & PROSTHETIC SOLUTIONS LLC
Entity Type:Organization
Organization Name:ORTHOTIC & PROSTHETIC SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANDRE
Authorized Official - Middle Name:SHONDALE
Authorized Official - Last Name:MOSTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:225-316-5444
Mailing Address - Street 1:7754 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4706
Mailing Address - Country:US
Mailing Address - Phone:225-243-9736
Mailing Address - Fax:985-256-2599
Practice Address - Street 1:2015 FAIRFIELD AVE STE E
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2066
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier