Provider Demographics
NPI:1407852023
Name:LEHOTAY, ADAM JOHN (CP)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:JOHN
Last Name:LEHOTAY
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:LEHOTAY
Other - Middle Name:
Other - Last Name:PROSTHETICS, LLC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:615 GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-1801
Mailing Address - Country:US
Mailing Address - Phone:304-344-0036
Mailing Address - Fax:304-344-5025
Practice Address - Street 1:615 GEORGIA ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-1801
Practice Address - Country:US
Practice Address - Phone:304-344-0036
Practice Address - Fax:304-344-5025
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CP2217224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6301016000Medicaid
WV6301016000Medicaid