Provider Demographics
NPI:1396231189
Name:PROSTHETIC & ORTHOTIC SOLUTIONS, LLC.
Entity Type:Organization
Organization Name:PROSTHETIC & ORTHOTIC SOLUTIONS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:EDITH
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-785-4047
Mailing Address - Street 1:66 MYRON ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1416
Mailing Address - Country:US
Mailing Address - Phone:413-785-4047
Mailing Address - Fax:413-785-4047
Practice Address - Street 1:45 WINTONBURY AVE STE 311
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2470
Practice Address - Country:US
Practice Address - Phone:860-904-2419
Practice Address - Fax:413-785-4048
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROSTHETIC & ORTHOTIC SOLUTIONS, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA335E00000X
CT335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier