Provider Demographics
NPI:1376069229
Name:CHILDREN'S ORTHOTICS AND PROSTHETICS LLC
Entity Type:Organization
Organization Name:CHILDREN'S ORTHOTICS AND PROSTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:LAURIE
Authorized Official - Last Name:PURDUM
Authorized Official - Suffix:
Authorized Official - Credentials:BOCO, BOCP
Authorized Official - Phone:702-932-1300
Mailing Address - Street 1:810 S DURANGO DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-2487
Mailing Address - Country:US
Mailing Address - Phone:702-932-1300
Mailing Address - Fax:702-848-4990
Practice Address - Street 1:810 S DURANGO DR STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-2487
Practice Address - Country:US
Practice Address - Phone:702-932-1300
Practice Address - Fax:702-848-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVC52329222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty