Provider Demographics
NPI:1689250151
Name:PELICAN ORTHOTICS AND PROSTHETICS
Entity Type:Organization
Organization Name:PELICAN ORTHOTICS AND PROSTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPRITTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-502-1841
Mailing Address - Street 1:69156 HWY 190 SERV RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5140
Mailing Address - Country:US
Mailing Address - Phone:985-276-4560
Mailing Address - Fax:985-276-4563
Practice Address - Street 1:69156 HWY 190 SERV RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5140
Practice Address - Country:US
Practice Address - Phone:985-276-4560
Practice Address - Fax:985-276-4563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty