Provider Demographics
NPI:1629776687
Name:OTTO BOCK PATIENT CARE, LLC
Entity Type:Organization
Organization Name:OTTO BOCK PATIENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PALLAVI
Authorized Official - Middle Name:CHINTAPALLI
Authorized Official - Last Name:NEMANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-552-6311
Mailing Address - Street 1:11809 DOMAIN DR UNIT 400
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-3452
Mailing Address - Country:US
Mailing Address - Phone:800-328-4058
Mailing Address - Fax:
Practice Address - Street 1:410 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3534
Practice Address - Country:US
Practice Address - Phone:870-743-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier