Provider Demographics
NPI:1477905669
Name:TOTAL CARE ORTHOTICS AND PROSTHETICS
Entity Type:Organization
Organization Name:TOTAL CARE ORTHOTICS AND PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESTOVANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-502-5975
Mailing Address - Street 1:1145 S UTICA AVE
Mailing Address - Street 2:SUITE G 12
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4000
Mailing Address - Country:US
Mailing Address - Phone:918-502-5975
Mailing Address - Fax:918-502-5980
Practice Address - Street 1:1145 S UTICA AVE
Practice Address - Street 2:SUITE G 12
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4000
Practice Address - Country:US
Practice Address - Phone:539-664-4422
Practice Address - Fax:918-779-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier