Provider Demographics
NPI:1376858688
Name:AMERICAN ORTHO TECH LABORATORIES, INC.
Entity Type:Organization
Organization Name:AMERICAN ORTHO TECH LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-397-0993
Mailing Address - Street 1:2534 EMPIRE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6710
Mailing Address - Country:US
Mailing Address - Phone:336-397-2165
Mailing Address - Fax:336-397-2167
Practice Address - Street 1:4809 MEMORIAL HWY STE 100
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-7515
Practice Address - Country:US
Practice Address - Phone:813-386-7121
Practice Address - Fax:813-386-7122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier