Provider Demographics
NPI:1346283850
Name:ORTHOPEDIC BRACE INC
Entity Type:Organization
Organization Name:ORTHOPEDIC BRACE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILKINS
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:321-639-0277
Mailing Address - Street 1:500 N WASHINGTON AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2759
Mailing Address - Country:US
Mailing Address - Phone:321-639-0277
Mailing Address - Fax:321-639-0143
Practice Address - Street 1:836 EXECUTIVE LN
Practice Address - Street 2:SUITE 110
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3597
Practice Address - Country:US
Practice Address - Phone:321-639-0277
Practice Address - Fax:321-639-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT 55335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier